Class of 2022 Prom Consent and Clearance Form

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ALL ATTENDEES MUST COMPLETE THIS FORM

Students have many opportunities to participate in various extra activities at or away from school. These activities can be an outgrowth of class activities, or in this case, a school sponsored safe and special prom evening that the Senior Class shares at The Field Museum in Chicago.

The school limits its responsibility for the safety and the welfare of the students by providing reasonable supervision by representatives of the school designated to supervise Prom.

Your signature below constitutes and is evidence of your agreement to do the following actions:

1. Accept general liability for the participation of your child in this activity.
2. Keep all of your insurance now in effect insuring your son or daughter.
3. Limit and restrict any claim against Hinsdale Township High School District #86, any of its teachers or representatives arising out of any act or omission regarding your son’s or daughter’s participation in the activity and transportation thereto as described below to the District’s available insurance policies.

ALL PROM ATTENDEES MUST HAVE PHOTO IDENTIFICATION IN THEIR POSESSION. YOU WILL NEED IT TO BOARD THE BUS.

Senior Class Faculty Sponsors: Maria Cotter and Kate Saunders

Email *

Hinsdale Central Student ID#: *

Hinsdale Central Student Last Name: *

Hinsdale Central Student First Name: *

The student named above has my permission to take part in the field trip to The Field Museum in Chicago for the Senior Prom on Saturday, April 30 departing Hinsdale Central High School at approximately 6:00 P.M. and returning at approximately 12:45 A.M. on May 1 to HCHS (*unless he/she/they is attending Post Prom which returns at approximately 3:45 A.M). *

I give my permission to take part in the field trip to The Field Museum in Chicago for the Senior Prom on Saturday, April 30 departing Hinsdale Central High School at approximately 7:00 P.M. and returning at approximately 12:45 A.M. on May 1 to HCHS (*unless he/she/they is attending Post Prom which returns at approximately 3:45 A.M).

Required

Parent/Guardian first and last name: *

Parent/Guardian cell number to contact in case of emergency: *

Does your child have any special health needs or food allergies? *

Yes

If you marked yes, please explain allergies:

Does the health condition require routine, preventive, or emergency medication(s) such as an inhaler or an Epi Pen? If yes, please supply the medication(s) with complete instructions and inform the faculty sponsors before April 27. *

Yes - If yes, please supply the medication(s) with complete instructions and inform the faculty sponsors before April 27.

Required

Will student be attending Post Prom? *

Yes - An additional permission form and fee will be required

Please note the name of your date/another person in your group:

Student's Cell phone number: *

A copy of your responses will be emailed to the address you provided.

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