Grad Night 2021 Permission Form
This permission form must be completely filled out and signed by the student and parents/guardians.

Grad Night Event is Friday, June 4, 2021, 6-10pm. Check in begins at 5:30pm.

Only Prospect graduated seniors and chaperones are permitted at Grad Night.
No other schools will be present and no guests are allowed.
There are no in/out privileges for graduates.
All graduates must arrive between 5:30 and 6:30pm. There is no late entry.

Items that are ok to bring: Yearbook, Student ID to show at entrance, warm jacket/sweatshirt, small drawstring bag
Items to leave behind: Money, Water Bottles, Purses, Backpacks, most everything else!
THIS IS A SAFE AND SOBER EVENT. Please be prepared to empty and show all contents of bags and jackets and pockets.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend masking and social distancing. Prospect High PTSA Grad Night committee has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you will not become infected with COVID-19. Our goal is to provide a safe environment for this event in accordance with state, county, and PTSA guidelines.
Sign in to Google to save your progress. Learn more
Student Section
In order to attend Grad Night 2021, I understand that I am responsible for the following: *
Yes
No
I agree to follow event, state and county guidelines for COVID-19 protocols including face coverings, appropriate social distancing, cleaning and disinfecting, hand hygiene and respiratory (cough or sneeze) etiquette as well as behaving respectfully to and following all rules specified by the chaperones, entertainment and the venue.
I understand I will be asked to leave the event if I misbehave or fail to remain masked and to abide by social distance protocols.
I voluntarily agree to notify phs2021gradnight@gmail.com if I contract COVID-19 within 10 days following this event. In doing so, I will allow Prospect High PTSA to notify all people who may have been potentially exposed while at this event to help reduce the risk of spread.
THIS IS A SAFE AND SOBER GRAD NIGHT!! If it appears you are under the influence of any substance (drugs or alcohol) you will not be allowed to attend Grad Night and the cost of your ticket will be forfeited. If you are found possessing alcohol or drugs, involved in a disruption or in any way representing a danger to yourself or others, you will be subject to removal from the premises and other appropriate action if necessary.
Student Signature
I have read and understand these rules and expectations for Prospect High PTSA Grad Night event and agree to abide by them. If I do not follow these rules, I understand that the privilege to participate in Grad Night activities may be revoked and my ticket price forfeited.  I agree that my signature on this document (my "E-Signature") is as valid as if I signed the document in writing.
Student Full Name *
Student E-Signature *
Student Email *
Parent Section
I have read and reviewed these expectations with my student and understand that I could be called to pick up my child at the venue if determined to be necessary by venue staff, security or chaperones.

The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of all individuals listed above in any and all of the PTSA sponsored activities.

I attest and verify that all individuals listed above are physically fit and able to participate in any PTSA sponsored activities. Further I acknowledge that is it my responsibility to understand any inherent risks associated with PTSA sponsored activities and communicate those risks to all individuals named above.

I/we, as parent(s) or guardian(s) of the minor(s), do hereby, for my child/children, myself, my heirs, executors and administrators, release and forever discharge and hold harmless the California State PTA, the local PTA and all officers, directors, employees, agents and volunteers of the organizations, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the participation of any individuals listed above in any PTA sponsored activities.

I/we grant permission to have photographs, video recordings and/or sound recordings taken during Prospect High PTSA Grad Night event and be placed on a shared website for participant access.

I agree that my signature on this document (my "E-Signature") is as valid as if I signed the document in writing.
Medical
I do hereby certify that to the best of my knowledge and belief all individuals named above are in good health. In the event that I, or other parent/guardian, cannot be reached in an emergency, I hereby give permission to secure proper treatment for my child(ren). I/we do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.
I/we hereby advise that the above named minor(s) has the following allergies, medicine reactions or unusual physical conditions, which should be made known to a treating physician: (If none, please write the word “none”. If yes, put first name of child and the allergy/condition.): *
By signing below, I confirm that I have carefully read and fully understand its contents. I am aware that this is a release of liability and signed it of my own free will.
Parent /Guardian E-Signature *
Parent /Guardian Email *
Parent/Guardian Phone *
Address, City, State, Zip
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy