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TPHS GRAD NITE 2008

PERMISSION / MEDICAL RELEASE FORM


Please Print Clearly

Senior’s Name: (First)_________________ (Last)_____________________


Parent’s Name: (First) _________________ (Last)_____________________
We have read the TPHS Grad Nite Guidelines and Registration and agree to behavior consistent with them. We
hereby agree to release the Torrey Pines High School Foundation, Torrey Pines High School, San Dieguito Union
High School District and the Torrey Pines High School Grad Nite Committee from any and all claims, liabilities,
actions, and causes of actions of any kinds, and hereby agree to hold the Torrey Pines High School Foundation,
Torrey Pines High School, San Dieguito Union High School District and the Torrey Pines High School Grad Nite
Committee harmless from any of the above arising out of the above named child’s traveling to, attending,
participating in and returning from any Grad
Nite activity. We recognize the advantage of Grad Nite and its purpose of saving lives by providing an alcohol-
free and drug-free environment for our graduating seniors. With this understanding, we hereby voluntarily
provide Torrey Pines High School Foundation, Torrey Pines High School, San Dieguito Union High School
District and the Torrey Pines High School Grad Nite Committee with this release of all claims and hold harmless
agreement.

Signature of Senior:____________________________________________
Signature of Parent:____________________________________________

CONTACT INFORMATION:
Senior’s cell phone: ______________________________________________
Parent(s) home phone: _______________ Parent cell phone ________________
Alternate Parent phone:______________ Alternate Parent cell phone:__________
Other Emergency contact name:_______________________ Phone:__________
Parent email:___________________________________________________
If contact numbers change prior to the event please contact us with your new information.

MEDICAL INFORMATION:
Physician name: ______________________Physician phone:_______________
Allergies or medical condition that may create an emergency:__________________
____________________________________________________________
PAYMENT:
Ticket Purchase Amount: $______________
Graduation Lei ($20): $______________
I would like to Sponsor a Senior: $______________
I would like to Make a Donation: $______________
Total Amount Enclosed: $______________ Check# _________
Grad Nite T-shirt Size:
Small_______ Medium_______ Large_______ X-Large_______ XXL _______

Make checks payable to: TPHS Foundation/Grad Nite


Mail check and white copy to: TPHS Foundation/Grad Nite
P. O. Box 2489
Del Mar, CA 92014-1789
OR drop off in the box at the TPHS Foundation Office in the Administration Building on campus.

WHITE COPY- GRAD NITE YELLOW COPY- PARENTS


TPHS FOUNDATION - GRAD NITE 2008
REGISTRATION INFORMATION
Date: June 12, 2008
Location: TPHS campus
Event Time: 11:00 pm to 5:00 am
Check-In Time: 11:00 pm to 11:30 pm

RULES FOR ATTENDANCE:


o Only TPHS seniors may attend
o PHOTO ID IS MANDATORY FOR ENTRY
o NO STUDENT ADMITTED WITHOUT A COMPLETED AND SIGNED
Permission / Medical Release Form
o Transportation of seniors to and from Grad Nite is MANDATORY BY A
PARENT OR RESPONSIBLE PARTY (including students 18 or older).
o As at any school function, the use, presence, or possession of alcoholic beverages
or other drugs is not acceptable. Parents will be notified to pick up their senior.
Smoking is not permitted.
o Admission will only be permitted between 11:00 and 11:30 pm on June 12,
2008. Seniors are encouraged to stay until 5 am the following morning.
o Should a senior become ill, the parent or guardian should be prepared to pick up
their senior at the checkout table.
o Purses and backpacks are discouraged: No money is needed during Grad Nite.
Personal items will be inspected by security upon entering. A check-in service
will be available in the gym. However, items checked in are the responsibility of
the senior. We encourage all students to put cell phones into their checked items
to minimize the loss or damage due to the evening’s activities.
o Seniors are encouraged to wear Grad Nite T-shirts.

PAYMENT INFORMATION:
o BEST VALUE -Take advantage of the discounted ticket price before March 31,
2008!
o You may sponsor an additional senior to attend Grad Nite. This donation is tax
deductible.

**BEST VALUE**
Feb 1 – Mar 31, 2008 April 1 - June 1, 2008

Ticket includes T-shirt $80 $100

Add an Orchid Lei for the Graduation Ceremony - $20 each


Lei order must be received before June 1, 2008

Questions please contact the Foundation office at (858) 793-3551

PLEASE KEEP THIS PAGE FOR REFERENCE


NO TICKET WILL BE SENT-
STUDENTS’ NAME WILL BE ON A LIST AT THE EVENT

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