M-A Grad Night

GRAD NIGHT REGISTRATION 2022-ENGLISH
IF YOU REGISTER ONLINE YOU DO NOT NEED TO SUBMIT A PAPER REGISTRATION
STUDENT INFORMATION:
Student Name*

Student First NameStudent Last Name
Student ID *
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

Parent First NameParent Last Name
Phone Number*

Area CodePhone Number
E-mail*
You will be emailed a receipt to this email
Date of Registration*

MonthDayYear
PERMISSION FORM/CODE OF CONDUCT FOR M-A CLASS OF 2022 STUDENTS
Student above has my permission to attend Grad Night 2022.

Date of Event: June 3, 2022

Check-In: 7:30 p.m.

Departure/Return Location: M-A High School's New Gym

Leader: PTA Grad Night Committee

Return: By 3:00 a.m., June 4, 2022

Method of Transportation: Bus

I understand that all students attending M-A Grad Night are expected to conduct themselves properly and be respectful to the transportation company employees, the employees at the venue, adult sponsors and chaperones. California state law prohibits the possession or use of alcoolic beverages or drugs by students. Therefore, various methods of drug and/or alcohol detection may be utilized. I understand that all students are required to go to and return from the event in the transportation provided. According to the policy of the chartered bus company, any clean-up necessary due to a student's action (ex. vomiting) will result in a $350 charge, which will be billed directly to the parents of the responsible student. All students must remain on the venue premises for the duration of the event. Students under any form of expulsion or who were involved in any drug or alcohol related incidences at the Prom or Senior activities (Spring 22) are not eligible to attent Grad Night. The admission price will be refunded if the student is ineligible to attend.
Parent/Guardian Signature (Regardless of students age)*

Note: Use stylus pen or finger on phones and iPads, laptop use mouse or click on touchpad and hold down to sign Clear
Student Signature (Regardless of students age)*

Note: Use stylus pen or finger on phones and iPads, laptop use mouse or click on touchpad and hold down to sign Clear
PARENT'S APPROVAL AND STUDENT WAIVER-Parents must sign for students under 18

California State PTA
My student, named above, has my permission to participate in Menlo-Atherton's High School GRAD NIGHT 2022, a PTA-sponsored event, including transportation by Sequoia School District busses, on Friday, June 3, 2022 to the Grad Night venue and back from 7:30 p.m. to 3:00 a.m. (June 4). The undersigned parent or guardian assumes all risks in connection with the student's participation in said event and, hereby releases and discharges The California State PTA, all PTA officers, employees, volunteers, and agents from all liability, claims or demands for any damage, loss or injury to the student, the student's property, or parent's property in connection with participation in this event. I hereby certify the student, named above, is my (son, daughter) and that his or her date of birth is correct above, and that to the best of my knowledge and belief said student is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood and agreed that the undersigned will assume full responsibility for any such action, including all costs associated with such emergency treatment. I hereby advise that the above named student has the following allergies, medicine, reactions, medical conditions or unusual physical condition which should be made known to a treating physician.
Medical Concerns*
(allergies, medicine reactions, medical conditions or unusual physical conditions-if none please write "none")
Parent/Guardian Signature for Students under 18-REQUIRED

Note: Use stylus pen or finger on phones and iPads, laptop use mouse or click on touchpad and hold down to sign Clear
PARTICIPANT WAIVER-Student 18 and over must sign this waiver

California State PTA
I, the undersigned participant, intending to be legally bound, do hereby for myself and heirs, executors, administrators and assigns, forever waive, release and discharge any and all rights, claims and actions for damages that I may have, or that may hereafter accrue to me against the California State PTA, including all unit council and district PTA's and all of their officers, directors, members and volunteers. I attest and verify that I am physically fit and able to participate in this event and acknowledge that I am aware of the inherent risks in participating in a event of this type.
Student Signature 18 or older-REQUIRED

Note: Use stylus pen or finger on phones and iPads, laptop use mouse or click on touchpad and hold down to sign Clear
Full Name of Attendee*

First NameLast Name
Signature-Student must sign if 18 & older. Parent/Guardian signature required for minors*

Note: Use stylus pen or finger on phones and iPads, laptop use mouse or click on touchpad and hold down to sign Clear
Date of Signature*

MonthDayYear
ACKNOWLEDGEMENT OF RISK FOR EVENT ATTENDANCE-M-A PTA
The undersigned acknowledge and agree to the following:
I am aware of the existence of risks to my physical health at the venue and based on my participation in M-A PTA Grad Night 2022.

I understand and accept the risk that participation in the event may cause injury or illness suchas, but not limited to Influenza, MRSA, or COVID-19, that may lead to a variety of conditions, including but not limited to paralysis or death. I am fully and personally responsible for my own safety and actions while and during my participation in the event and I recognize that I may be at risk of contracting COVID-19, regardless of the precautions taken by me, the PTA and the Grad Night venue.

With full knowledge of the risks involved, I hereby assume all risks of participation and forever release, waive, discharge the M-A PTA, its board,officers, shareholders, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentionalexposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless the M-A PTA from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claimsmade by or against any of the released party due to injury, loss, or death from or related to COVID-19.
Full Name of Attendee*

First NameLast Name
Signature-Student must sign if 18 & older. Parent/Guardian signature required for minors*

Note: Use stylus pen or finger on phones and iPads, laptop use mouse or click on touchpad and hold down to sign Clear
Date of Signature*

MonthDayYear
PURCHASE GRAD NIGHT 2022 TICKET
The PTA's goal is to include the entire Senior 2022 graduating class in Grad Night. We are in need of sponsors for 100 studetns. Please consider helping us with this goal by sponsoring a students Grad Night ticket. Any amount of donation is greatly appreciated.
GRAD NIGHT TICKET PRICES AND PAYMENT OPTIONS*

Single Ticket $130 + $5 PayPal ChargeSingle Sponsorship Ticket for Student in Need $130 + $5 PayPal ChargeSingle Ticket and Single Sponsorship Ticket $260 + $5 PayPal ChargeCash or Check $130 M-A Front Office-Make checks out to M-A PTACheck $130 Mail to PTA Grad Night, 555 Middlefield Road, Atherton, CA, 94027 - Make checks out to M-A PTAPartial Scholarship Cash or Check $20 M-A Front Office-must be approved-you will receive notification after you submit registration/waiverFull Scholarship must be approved-you will receive notification after you submit registration/waiver from gradnight@maptabears.com.
GRAD NIGHT TICKET $130 ($5 PayPal Charge)

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GRAD NIGHT REGISTRATION 2022-ENGLISH

IF YOU REGISTER ONLINE YOU DO NOT NEED TO SUBMIT A PAPER REGISTRATION

STUDENT INFORMATION:

PARENT/GUARDIAN INFORMATION:

PERMISSION FORM/CODE OF CONDUCT FOR M-A CLASS OF 2022 STUDENTS

PARENT'S APPROVAL AND STUDENT WAIVER-Parents must sign for students under 18

PARTICIPANT WAIVER-Student 18 and over must sign this waiver

ACKNOWLEDGEMENT OF RISK FOR EVENT ATTENDANCE-M-A PTA

PURCHASE GRAD NIGHT 2022 TICKET