Professional Documents
Culture Documents
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 _______
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