You are on page 1of 5

WESTFIELD HIGH SCHOOL 2012 ALL NIGHT GRADUATION PARTY ATTENDANCE GUIDELINES

The All Night Graduation Party (ANGP) is a drug- and alcohol-free opportunity for our senior students to celebrate their graduations. The party will be held on June 18th at Fast Eddies in Centreville, VA. The facility is reserved for Westfield High School (WHS) grads only the PTSA volunteers and Fast Eddies staff are there to make this the greatest party for our seniors ever! Here are a few reminders: Tickets must be purchased in advance for this great event no tickets will be available at the door. Come hungry and ready to have fun tickets include all activities as well as great prizes and an all-night buffet! No need to bring extra money! This is a local venue, so transportation will be the responsibility of students and parents. Participation in the All Night Graduation Party (ANGP) celebration is a PTSA School Sponsored event and, therefore, all the provisions in the Student Responsibilities and Rights (SR&R) apply.

As with any event of this size, there are a few rules that will keep the venue fun and safe. 1. Attendees MUST be 2012 graduates of WHS or eligible 2011 foreign exchange students. We know its a cool party, but no crashers are allowed, including non-WHS dates, siblings, or children of graduates. 2. Forms, forms and forms! All attendees must turn in the following to the WHS Main Office by June 11, 2012: Parental Authorization & Acknowledgement of Risk and Attendance Rules; Emergency Care Information; Medication Authorization (if applicable); and Fast Eddies Mechanical Bull (if permission is given). Even if youre 18, parents must sign the forms! 3. Check in of attendees begins at 11:15. Students should arrive no later than 12 a.m. to join the fun. If we have a ticket reservation and the student doesnt show, a call home will be made to confirm non-arrival. 4. Sorry no refunds are available! 5. No need to bring a purse or backpack to the event (theyre not allowed.) A sport bag will be provided to hold wallets, keys, cell phones and any authorized medications it will also be handy for carrying fun stuff like raffle tickets and prizes! 6. Students are now graduates obviously, theyre responsible for keeping track of their own belongings. 7. NO OUTSIDE FOOD OR DRINK PERMITTED. 8. Graduates should dress appropriately in casual clothes and wear comfortable shoes. Keep it clean, folks! 9. The all night part of ANGP means exactly that! There will be great casino games, dancing, photo booths, a money machine, tattoo artist (temporary, of course) and other activities to keep students busy until the 4 a.m. end of the party. In an emergency or if a student has a pre-authorized need to leave the fun early, parents must be present for dismissal. 10. Obviously, we need working phone numbers for parents or guardians in case of an emergency. We know its late and that older folks (yes we mean parents and guardians) get tired, but please be available by phone in case of the aforementioned emergency or if an issue arises. Parents are responsible for grads once they leave. 11. If a graduate needs to carry medication and/or supplies (including things like inhalers, diabetic supplies, etc.) then the MEDICATION AUTHORIZATION FORM must be completed and returned. 12. Again, attendees are proud WHS graduates and expected to behave in a respectful manner. Remember: the Student Responsibilities and Rights are in full force. Any attendee who behaves inappropriately or causes damage to property may be asked to leave the celebration and agrees that if asked to leave, he/she will do so. The parent/guardian will be contacted and made aware of the situation prior to the student leaving Fast Eddies. In most cases, the parent/guardian will be asked to retrieve the student.

PARENTAL AUTHORIZATION & ACKNOWLEDGEMENT OF RISK


WESTFIELD HIGH SCHOOL 2012 ALL NIGHT GRADUATION PARTY

FOR ALL ATTENDEES: PLEASE SIGN AND RETURN to the WHS Main Office by June 11, 2012
. No risk form = no admittance to the event!

By signing below, the graduate and their parent/guardian agree to the following: The ANGP is a PTSA, School-Sponsored event. All the provisions in the Student Responsibilities and Rights apply to the event. Permission to ride the MECHANICAL BULL requires a separate permission form. The graduate and their parent/guardian are responsible for the graduates actions. We have read and agree to the attached attendance guidelines. The parent/guardian and graduate agree to respect and accept the decisions made by the ANGP committee and its volunteers regarding any actions pertaining to the graduate and the attendance rules. The parent/guardian MUST be available by phone throughout the night. A graduate suspected of being intoxicated by alcohol or drugs, or smells of alcohol or drugs during check in will NOT be allowed to attend the event. If a graduate is suspected of intoxication during the event, he/she will be removed. In the event of such an issue, the student will be held in a separate area and WHS security personnel (including police officers on duty for the event) will be notified. Parents/guardians. The parent/guardian will be asked to come pick the graduate up and transport him/her home. The graduate WILL NOT BE ALLOWED TO DRIVE HIMSELF/HERSELF HOME and will be held until the parent/guardian arrives. Similarly, any graduate who causes a disturbance during the event will be asked to leave. Disturbances include physical fighting, yelling angrily at another graduate or chaperone, stealing, improper touching (as defined in the SR&R) and destruction of the school, rental facility, rental equipment, or ANGP property or the property of any attendee or volunteer. The parent/guardian of the graduate will be asked to pick the graduate up and transport him/her home. We, the undersigned, hereby release and agree to hold the Westfield High School PTSA, the 2012 ANGP Committee and its volunteers, employees, and other officers, staff members, and agents blameless from any and all claims that may arise from my use and/or my child's use or presence on and at such premises and activities. To the best of our knowledge, the graduate/my child is physically able to safely participate in this celebration and all if its activities.

_______________________
Printed Student Name

________________________
Student Signature

__________
Date

________________________
Printed Parent/Guardian Name

________________________
Parent/Guardian Signature*

__________
Date

* Parents/Guardians must sign even if graduate is 18 years of age or older.

EMERGENCY CARE INFORMATION

WESTFIELD HIGH SCHOOL 2012 ALL NIGHT GRADUATION PARTY

FOR ALL ATTENDEES: PLEASE SIGN AND RETURN to the WHS Main Office by June 11, 2012
In the case of emergency, volunteers staffing the party will call 911. Every effort will be made to contact a parent, a guardian, or a designated emergency contact. Please complete reverse side if graduate is authorized to carry medication(s) and/or medical supplies during the ANGP.

STUDENT NAME:___________________________________
IN CASE OF EMERGENCY DURING THE ANGP, CONTACT: Printed Parent/Guardian Name(s):____________________________________________________________ Home Address:____________________________________________________________________________ Home Phone Number:_________________________ Cell Phone Number:_________________________ Work Phone Number and/or Pager:_________________________email:________________________ LIST 2 PERSONS WE SHOULD CALL IN AN EMERGENCY IF THE PARENT(s)/ GUARDIAN(s) CANNOT BE REACHED: Contact Name:______________________________ Phone Number:___________________________ Contact Name:______________________________ Phone Number:___________________________ INSURANCE INFORMATION My child has medical coverage with ___________________________________________________________
Insurance Carrier Please indicate all current health conditions that apply for your child. Provide specifics, where necessary: Asthma ______ Hemophilia ______Cancer ______ Seizures ______Diabetes ______ Vision Problems: Glasses__ Contacts__ Heart Problems (be specific) ________________________________________________ Physical Disability (be specific) _____________________________________________ Respiratory (be specific) ___________________________________________________ Other (be specific) ________________________________________________________ ALLERGIES: Please list ALL ALLERGIES your child has; include medication, food, environmental, and other allergies. If your child is allergy free, write NONE. ____________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Please list all medications and dosages that your child receives on a continual basis: ____________________________________________________________________________________________________________ __________________________________________________________________________________________________________

_______________________
Printed Parent/Guardian Name

________________________
Parent/Guardian Signature*

__________
Date

* Parents must sign even if graduate is 18 years of age or older.

FAST EDDIES MECHANICAL BULL PARTICIPANT AGREEMENT, RELEASE AND ASSSUMTION OF RISK In consideration of the services of Harco III Inc. T/a Fast Eddies their agents, owners, officers, volunteers, participants, employees, and all other person or entities acting in any capacity on their behalf (hereinafter collectivity referred to as), I hereby agree to release, indemnify, and discharge on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows: 1. I acknowledge that riding a mechanical bull entitles known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities to the activity. The risks include, among other things: falling off or being thrown from the bull, which could result in musculoskeletal injuries including neck, head, and back injuries. Furthermore, Harco III Inc.T/a Fast Eddies employees have difficult jobs to perform. They seek safety but they are not infallible. They might be unaware of a participants fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction. 2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of equipment or facilities, including any such claims which allege negligent acts or omissions. 4. Should Harc III Inc.T/a Fast Eddies or anyone acting on their behalf be required to incur attorneys fees and cost to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. Further certify that am willing to assume the risk of any medical or physical condition I may have. 6. In the event that I file a lawsuit against Harco III Inc.T/a Fast Eddies I agree to do so solely in the state of the Commonwealth of Virginia and I further agree that the substantive law of that state shall apply in that action without regards to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Harco III Inc.\ T/a Fast Eddies on the basis of any claim form which I have release them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. Print Name of Participant: Address: Phone : Parent/Guardian Printed Name: Parent/Guardian Signature: __ ___ _________ ____ _________Date: _____________ _________________

______________________________ __________ ___________

Parents must sign even if graduate is 18 years of age or older.

MEDICATION AUTHORIZATION
Release and Indemnification Agreement WESTFIELD HIGH SCHOOL 2012 ALL NIGHT GRADUATION PARTY

COMPLETE THIS SIDE OF THE FORM ONLY IF YOUR CHILD WILL BE CARRYING MEDICATION DURING THE PARTY.
Note: Parents/guardians are required to sign and return this form by June 11, 2012. Return signed form to ANGP box located in the Westfield High School Main Office. Westfield High School, 4700 Stonecroft Blvd, Chantilly, VA 20151

Due to medical necessity, I do hereby give my permission for my child, __________________________, to keep on his/her person at all times for the duration of the All Night Graduation Party celebration and to self administer the following medication(s) and/or medical supplies/equipment that are listed below. Please be as specific as possible when listing. For medications, include dosages and times to be taken. 1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________ 4. _____________________________________________________________ 5. _____________________________________________________________

________________________

________________________

__________
Date

Printed Parent/Guardian Name Parent/Guardian Signature* * Parents must sign even if graduate is 18 years of age or older.

I hereby release and agree to hold the Westfield High School PTSA, the 2011 ANGP Committee and its volunteers, employees, any other officers, staff members, and agents blameless from any lawsuits, claims, expenses, demands or actions, etc. against them for permitting my child to carry and self administer the above mentioned medications and/or medical supplies/equipment for which I have given permission.

________________________
Printed Parent/Guardian Name

________________________
Parent/Guardian Signature*

__________
Date

Parents must sign even if graduate is 18 years of age or older.