June 14, :30pm - 5:30am

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1 June 14, :30pm - 5:30am Zip Lines Rock Climbing Magician Tattoos Dancing DJ Prizes, Prizes, Prizes Food, Food, Food Go-Kart Racing Laser Tag All Del Norte Seniors are invited to attend the 2018 Grad Nite on Thursday, June 14, Grad Nite is a safe, sober, alcohol-free event celebrated on graduation night. Ticket prices will increase as on January 1, 2018 so order your ticket now before prices rise $ 125 Please fill out the information below and return this form along with the permission slip/student waiver and cash or check made payable to: DEL NORTE PTSA Student s (Print) Girl Boy Homeroom Teacher Parent s (Print) Parent s Phone Parent s Student s T-shirt Size (Circle One) S M L XL XXL Committee Use Only Date Amount Paid Check # Initials Waiver#1 Waiver#2 _ Credit Card Number Expiration Ver. Code Zip Code Donation: Amount: Surcharge $5 Last 4 Digits of Card Tickets are non-transferable & non-refundable.

2 DEL NORTE PTSA GRAD NITE 2018 PERMISSION SLIP/STUDENT WAIVER #1, birthdate has my/our permission to participate in DNHS PTSA Grad Nite on Thursday, June 14, 2018 at the Miramar Speed Circuit from 10:30pm-5:30am. We also understand and agree to release Del Norte, Del Norte PTSA, Palomar Council, Ninth District, California State PTA, Del Norte Grad Nite Committee, The Poway Unified School District (PUSD) and their employees and agents, from any and all liability, charges, claims, costs and expenses of every kind and nature whatsoever in connection with my student s participation in Grad Nite on June 14-15, I certify that to the best of my knowledge and my belief that my student is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs. I hereby advise that the student named below has had the following allergies, medicine reactions or unusual physical condition which should be made known to a treating physician. (If none, please write the word none ). I/We agree that I/we will instruct my/our daughter/son that he or she must adhere to the rules of conduct of Miramar Speed Circuit & Party Pals. We agree that the student will not bring any alcoholic beverages or drugs to the school grounds or arrive under the influence of alcohol or drugs. We also understand that once the student enters the Grad Nite area, he/she may not leave before the end of Grad Nite unless special permission is granted. Once he/she leaves Grad Nite, he/she may not return to the event. Personal items will not be allowed to be brought into the event. We have been informed of the rules and liability release of Grad Nite. Student : (Print) Student Signature: Parent/Guardian : (Print) Parent/Guardian Signature: Emergency Contact : Emergency Phone Number: Parent s NO STUDENT WILL BE ALLOWED INTO GRAD NITE WITHOUT ALL COMPLETED FORMS (Ticket Order Form, Student Waiver & Transportation Form)

3 Important! DEL NORTE PTSA GRAD NITE 2018 TRANSPORTATION AGREEMENT WAIVER #2 Transportation Form - Drop-off and Pick-up!! Sign and Return by Friday, April 28, 2017! Student/Parent Agreement - I understand that during my attendance at Grad Nite I must follow the rules and directions of the chaperones and the establishment hosting the event. I understand that I may not leave Grad Nite and that I must be picked up by an authorized parent/guardian. I agree to these requirements. Student s (print) Student s Signature Parent Drop-off/ pick-up agreement - June 14-15, 2018 Student must be on bus in order to go to Grad Nite Event Bus leaves at 10:15pm from Del Norte High School, students must be at Del Norte High School at 9:30 pm for check-in. Pick up from Del Norte High School is promptly at 5:30 a.m. on June 15, 2018 ONLY Authorized Parent or Guardian PICK-UP DRIVER(S) 21 and older drivers only!! Print name(s) with phone numbers. Phone Number Phone Number I the parent or authorized adult MUST drop-off and pick-up student from Del Norte High School. All information is accurate on this form which will be on file. Parent s (print) Signature Parent's Phone numbers Thank you! We have your child's safety as foremost importance.

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