WAIVER LIABILITY & REGISTRATION PACKET
Kealakehe High School & West Hawaii Explorations Academy
Project Graduation 2017
May 27 – 28, 2017
MUST BE COMPLETED & RETURNED BY May 26 – KEEP TOP SHEET FOR REMINDER
This event will be a “lock-in” and students are not permitted to leave. Security and chaperones are on site to insure their safety. In past years, Kealakehe’s senior participation rate has been approximately 80%, but our goal is 100%. There will be lots of exciting activities to keep the evening going but there will also be areas to relax, kick back or just talk and listen to music. This isa fun and safe way for your child to spend his/her last night as a high school student with their friends.
WHAT TO BRING ON SATURDAY, MAY 27, 2017:
- Change of clothes
- Comfortable footwear/socks
- Bathing suit (NO G-STRINGS) and a plastic bag for wet clothes
- Toiletries (make up, hairbrush, deodorant, contact solution, etc); we will provide toothbrushes, toothpaste, shampoo, soap, conditioner and ladies sanitary products
- Important medication (labeled)
- Only 2 leis (ribbon, yarn, artificial floral) no candy or floral allowed. POOL RULES!
- Cell Phones, Cameras, MP3 players, or money, etc –bring valuables at your own risk – money; you will not be able to buy anything!
WHAT NOT TO BRING:
- Drugs, tobacco (including e-cigarettes) or alcohol
- No more than 2 ribbon, yarn or artificial leis
- Towel or bath robe – we provide both for you at pool
- Purses or backpacks – bags and purses will not be allowed that night. You will receive a Waverider logo bag at the check in table to pack your belongings in. It will be transported to the pool and waiting for you upon arrival. We will have a zip lock bag available to organize belongings.
REGISTRATION FOR THE GRAD NIGHT EVENT
On graduation day, May 27th, those who have registered and paid must check in at the school gym entrance to receive your logo bag and hoodie. At that time, you will fill your logo bag with the items recommended above, which will be transported to the gym for your arrival. ALL BAGS ARE SUBJECT TO SEARCH FOR CONTRABAND. You will also be given a wrist band ID which designates the bus you are to board (RED, BLUE, GREEN OR YELLOW). You must wear this ID band all night.
Plan ahead and pack comfortable clothing. Have your parents bring your change of clothes to graduation and change in the gym before you board the bus. Your FAMILY should collect your cap/gown/grad clothing and leis OUTSIDE of the gym as NO BAGS or PURSES will be allowed on the buses.
RULES & PROCEDURES
Any student found in possession of drugs, alcohol, tobacco, or displays disorderly conduct will be asked to leave. Police and parents will be called immediately and parents will be responsible to pick up the offending student. Chaperones will ensure a safe evening for all and are there to support you.
It is the policy of Project Grad to appropriately search students prior to boarding the bus to ensure the safety of all. All swimmers must shower before entering the pool and wear appropriate swimwear (NO G-STRING BOTTOMS PERMITTED)
Students will not be permitted to leave the event, except for medical emergencies.
PERMISSION, REGISTRATION AND LIABILITY WAIVER
My Son/Daughter ______has my permission to attend Kealakehe Project Grad 2017. I know this event is offered to all graduates and it is being planned by a group of volunteer students, parents and supportive adults. I understand that participation in this event is fully voluntary. In consideration of the benefits to be derived and having full confidence that every precaution will be taken to ensure the safety of my child, my signature below shows my understanding of this event.
I am fully aware that my child will be involved in the following activities: Bowling, video games, DJ music, live band and dancing, swimming, various gym activities including but not limited to basketball, zumba, bouncing castle, temporary tattoos, hair styling, face art, laser tag, inflatable bungee run, and any other venue/activities the Project Grad Committee has secured for this event, including but not limited to a bus ride from Kealakehe High School to Kona Pool/Gym and a bus ride from the Kona Gym to KBXtreme.
I agree to waive any and all claims and not to place suit or hold liable any volunteer persons (s), Kealakehe Project Grad (a non-profit organization), board or committee member for any incident or injury that may occur to my child while attending this event. I will be responsible for payment for any medical services that may be required.
I attest that to the best of my knowledge my son/daughter will arrive at this Project Grad 2017 event free of drugs, alcohol, tobacco, or any Kealakehe High School-defined banned material. I understand that if my son/daughter is found to be in possession (with the exception of personal medication) or under the influence of drugs, alcohol, tobacco, or any Kealakehe High School-defined banned material, or displays unruly conduct, I agree to pick him/her up immediately. No refund will be considered. Under NO circumstances will my son/daughter be allowed to drive home. Parents/Guardians will be responsible for any damage attributed to their child at any party location. The police may also be notified if the situation warrants it.
______
Print Name of Student over 18 years old Signature of Student over 18 years old
OR IF STUDENT UNDER 18:
______
Print Name of Parent/Legal GuardianSignature of Parent/Legal Guardian
______
Date
STUDENT AGREEMENT- ALL STUDENTS MUST SIGN BELOW
I understand that if I violate any rules set by the Project Grad Committee or if I am determined to be in possession of or under the influence of drugs, alcohol, tobacco or any Kealakehe High-defined banned material, my parent/legal guardian will be notified to immediately pick me up. I also understand that I and my parent/legal guardian will be responsible for any expenses incurred due to my behavior and that the police may be notified if the situation warrants it.
______
Print Senior NameSignature of Senior
EMERGENCY INFORMATION & DESIGNATED ADULT PICK UP
PLEASE LIST ANY SPECIAL HEALTH CONDITIONS AND/OR SPECIAL EQUIPMENT USED BY STUDENT:
______
Any allergies (food, medication, other)?:______
Medications taken on a regular basis: ______
Please place any medications with an authorization slip in a clear re sealable bag labeled with the student’s name. Prescription medications MUST be in its original container with the student’s name on it. Turn in bag at the time of check - in.
PERSON TO CONTACT IN CASE OF EMERGENCY ON THE NIGHT OF THE EVENT: (MUST BE AVAILABLE)
NAMERELATIONSHIPPHONE
ALTERNATE NAME AND # IF NO ANSWER AT FIRST #PHONE
In the event of illness or injury to said student, I hereby consent to and authorize such medical and dental treatment necessary and agree to pay for such medical and dental costs if incurred ____ yes _____ no
If ‘No’ please indicate directions you want followed or course of treatment:
______
______
Print name of Parent/Legal GuardianSignature of Parent/ Legal Guardian
ALL STUDENTS (INCLUDING 18 YEARS OF AGE AND OLDER) MUST BE PICKED UP BY AN ADULT
I,______(Parent/Guardian) agree that only ______or ______(first & last names), are the designated adults authorized to pick up my son/daughter, ______(name) and will provide identification, at 5:00 am on SUNDAY, MAY 28, 2017 at KBxtreme**.
PARENT/GUARDIAN MUST COME TO THE EXIT AREA AND PROVIDE IDTO SIGN OUT YOUR STUDENT.
We, the undersigned, acknowledge our responsibility for our son/daughter once he/she is officially signed out from the event, and in an effort to prevent fatigue-related events, we also assume responsibility to see that he/she does not drive until fully rested.
______
Print Mother/Father/Guardian NameSignature of Mother/Father/Guardian
PHONE # OF ADULT/ADULTS DESIGNATED TO PICK UP STUDENT:______
ALTERNATE NAME AND # IF NO ANSWER:______
** STUDENTS NOT PICKED UP BY 6:00AM MAY BE TRANSPORTED TO NEAREST POLICE STATION FOR PICK UP.
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KEALAKEHE PROJECT GRAD