2024 Grad Nite Parent Waiver and Student Registration

Student's Name*

First NameLast Name

Student Mobile Number (or best contact if no mobile)*

Please enter a valid phone number.

Student Email (non-PUSD is fine)*

example@example.com

Birthday*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian 1 Name*

First NameLast Name

Parent/Guardian 1 Mobile Number (or best contact if no mobile)*

Please enter a valid phone number.

Parent/ Guardian 1 Email*

example@example.com

Parent/Guardian 2 Name

First NameLast Name

Parent/Guardian 2 Mobile Number (or best contact if no mobile)

Please enter a valid phone number.

Parent/ Guardian 2 Email

example@example.com

Student T-Shirt Size*

I (we) hereby advise that the above-named student has had the following allergies, medicine reactions or unusual physical condition, which should be made known to a treating physician or which could limit participation in this activity.*

NoYes (If yes, describe below)

Record medical concerns or conditions here:

I (we) as parent(s) or guardians(s) of the graduate, regardless of his/her age, do hereby, for my(our) graduating senior, and I, as the student myself, and my (our) heirs, executors and administrators to remise, release and forever discharge POWAY HIGH SCHOOL PTSA, PALOMAR COUNCIL PTA, 9TH DISTRICT PTA, and the California Congress of Parents, Teachers, and Students, Inc. (California State PTA), and all PTA officers, employees and agents of each of the foregoing, acting officially or otherwise, from any and all claims, demands, actions or causes of action on account of referred. I (we) do hereby certify that to the best of my (our) knowledge and belief said student is in good health. In case of illness or accident, I/we understand that every effort will be made to contact me. In the event I/we cannot be reached, I/we hereby give permission to the licensed health-care practitioner selected by the adult volunteers in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections or administration of medication for my child. 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 (we) understand that my (our) senior will also have to complete their waiver, a link for which is found on the PowayPTSA.org website.

I (WE) ALSO UNDERSTAND THAT MY STUDENT WILL REMAIN WITHIN THE GRAD NITE AREA FOR THE ENTIRE EVENT ON JUNE 6th, UNTIL THE END OF THE EVENT AT 2:30 AM, OR UNTIL A PARENT/GUARDIAN CHECKS HIM/HER/THEM OUT THROUGH STAFFING/SECURITY AS A RESULT OF PRE-ARRANGED SPECIAL CIRCUMSTANCES, ILLNESS ETC. (PARENT/GUARDIAN ID REQUIRED)

*Transportation is provided and students MUST take PUSD provided transport to and from event.

Participants MUST arrive at the PHS for check in NO LATER THAN 8:30 PM. Students who arrive after 9:00 PM will be denied participation.

Your signature and student's attendance at the Grad Nite Event gives your permission for your student to be photographed unless otherwise noted in writing.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature*

2024 Grad Nite Ticket must be purchased to complete registration. For general information, please go to our website. Receipts will come from our vendor, JotForm; please check your spam folders if you do not receive a receipt.

Grad Nite Admission (includes $4 processing fee) Product Image

Grad Nite Admission (includes $4 processing fee)Student Admission (Required)

$154.00 Quantity

Sponsor a Member of the Class of 2024 Product Image

Sponsor a Member of the Class of 2024Grad Nite is a PTSA event and we would like to ensure all who wish to attend are able to. Please consider sponsoring a student!

$125.00 Quantity

Sponsor a Member of the Class of 2024Grad Nite is a PTSA event and we would like to ensure all who wish to attend are able to. Please consider sponsoring a student!

$50.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.