La Costa Canyon Grad Night 2019 Permission Slip
When: Friday, June 14th, 2019
Time: 9:45pm ~ 5am
Questions? Contact Christy Monko (760) 271-2742 or csmonko@gmail.com
Please submit one form per graduate.
If you would prefer to turn in a print-out, please click on the following link http://lcchsfoundation.org/wp-content/uploads/2018/07/2019_LCC_GRAD-NIGHT_PermSlip.pdf
Graduate's Last Name *
Your answer
Graduate's First Name *
Your answer
Graduate's Student ID# *
Your answer
Parent/Guardian Name(s) *
Your answer
GRADUATE AGREEMENT
I HAVE READ AND UNDERSTAND THE 'GRAD NIGHT POLICIES AND PROVISIONS' PERTAINING TO MY PARTICIPATION IN GRAD NIGHT ON FRIDAY, JUNE 14TH, 2019. I MUST BE DROPPED OFF BETWEEN 9:45PM AND 10:00PM FOR CHECK-IN AT LA COSTA CANYON HIGH SCHOOL, FROM WHERE I WILL BE BUSSED TO THE PARTY LOCATION. I AGREE NOT TO CARRY ONTO THE BUS OR VENUE PREMISES ANY SUBSTANCES, SUCH AS TOBACCO, DRUGS, ALCOHOL, OR WEAPONS, WHICH WILL AFFECT MY BEHAVIOR AND/OR WILL HAVE A DETRIMENTAL EFFECT ON MY, OR OTHER'S, SAFETY AND/OR ENJOYMENT OF THE EVENING. I UNDERSTAND THAT IF I ARRIVE TO THE BUSSING LOCATION UNDER THE INFLUENCE OF ANY SUBSTANCE, SUCH AS DRUGS OR ALCOHOL, I WILL NOT BE ALLOWED TO PARTICIPATE IN GRAD NIGHT. I ALSO UNDERSTAND THAT, ONCE I ENTER THE PARTY, I MAY NOT LEAVE UNTIL 4:45AM UNLESS PRIOR ARRANGEMENTS HAVE BEEN MADE IN ACCORDANCE WITH THE 'GRAD NIGHT POLICIES AND PROVISIONS', AND I AM ACCOMPANIED BY MY PARENT/GUARDIAN. I AGREE TO THESE PROVISIONS AND AM LOOKING FORWARD TO A SAFE AND MEMORABLE GRAD NIGHT CELEBRATION!
Graduate Digital Signature *
Your answer
RELEASE OF ALL CLAIMS/HOLD HARMLESS & INDEMNITY AGREEMENT – PARENT/GUARDIAN AGREEMENT
WE HAVE READ THE 'GRAD NIGHT POLICIES AND PROVISIONS' AND AGREE TO SUPPORT THE BEHAVIOR EXPECTATIONS DESCRIBED THEREIN. WE HEREBY AGREE TO RELEASE THE SAN DIEGUITO UNION HIGH SCHOOL DISTRICT (SDUHSD), LA COSTA CANYON HIGH SCHOOL FOUNDATION (LCCHSF), AND THE LA COSTA CANYON GRAD NIGHT COMMITTEE FROM ANY AND ALL CLAIMS, LIABILITIES, ACTIONS, AND CAUSES OF ANY KIND. WE HEREBY AGREE TO HOLD HARMLESS AND INDEMNIFY SDUHSD, LCCHSF, AND THE GRAD NIGHT COMMITTEE FROM ANY OF THE ABOVE, ARISING FROM THE ABOVE-NAMED GRADUATE'S TRAVEL TO, ATTENDANCE, PARTICIPATION AND RETURN FROM ANY GRAD NIGHT ACTIVITY. WE RECOGNIZE THE BENEFITS OF GRAD NIGHT AND ITS MISSION TO SAVE LIVES BY PROVIDING A FUN AND MEMORABLE EVENING FOR OUR GRADUATING SENIORS, IN AN ALCOHOL AND DRUG FREE ENVIRONMENT. WITH THIS UNDERSTANDING, WE HEREBY VOLUNTARILY PROVIDE SDUHSD, LCC HIGH SCHOOL, THE LCCHS FOUNDATION, AND THE GRAD NIGHT COMMITTEE WITH THIS 'RELEASE OF ALL CLAIMS/HOLD HARMLESS AND INDEMNITY AGREEMENT.'

I GIVE PERMISSION FOR THE ABOVE-NAMED GRADUATE TO PARTICIPATE IN THE GRAD NIGHT CELEBRATION AT PARTY PALS. I UNDERSTAND THAT I AM RESPONSIBLE FOR DROPPING OFF AND PICKING UP THE GRADUATE AT LA COSTA CANYON HIGH SCHOOL.

Parent/Guardian Digital Signature *
Your answer
Best Parent/Guardian Phone # (during Grad Night) *
Your answer
Alternate Emergency Phone # *
Your answer
Parent/Guardian Email *
Your answer
Physician's Name *
Your answer
Physician's Phone # *
Your answer
Graduate's allergies or medical condition in case of emergency *
Your answer
I will pay by cash or check
Please bring cash or check to the LCC Foundation office Mon-Fri, 9am-3pm. Checks should be made payable to 'LCC Foundation' with 'Grad Night' and graduate's name in the memo. Cash should be in an envelope with the graduate's name and contact number or email.
In addition to my son's/daughter's ticket of $125 (or $145 after 5/31/19), I would like to support a graduating student who would not otherwise be able to attend Grad Night.
Donate online here
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=4HHKWDD2CAJP2

OR bring a check to the Foundation Office made payable to 'LCC Foundation' with 'Grad Night Donation' in the memo section.

Donation? *
Required
My business/company would like to be a sponsor of LCC Grad Night.
Grad Night Sponsor? *
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