Grad Night 2020 - Permission Form
PLEASE DO NOT COMPLETE THIS FORM UNTIL YOU HAVE PURCHASED YOUR STUDENT'S GRAD NIGHT TICKET VIA THE ATHLETICS BOOSTERS WEBSITE - http://www.encinalboosters.org/

* GRAD NIGHT IS NOT INCLUDED IN ANY SENIOR'S PACKAGE YOU MAY HAVE PURCHASED AT THE BEGINNING OF THE SCHOOL YEAR. *

GRAD NIGHT WILL BE HELD AT SCANDIA FUN CENTER IN FAIRFIELD, CA! CHARTER BUSES LEAVE EHS ON THURSDAY, JUNE 4TH @ 6:45PM AND ARRIVE BACK TO EHS ON FRIDAY, JUNE 5TH @1:00AM. STUDENTS TRAVEL BY CHARTER BUS ONLY - NO PARENT OR STUDENT VEHICLES ALLOWED.
TICKETS ARE $52.00 PER STUDENT. TICKET PRICES INCREASE TO $67.00 AFTER APRIL 2, 2020.
TICKET SALES END MAY 18, 2020. TICKET NUMBERS ARE LIMITED SO DON'T DELAY.

Your student can not attend Grad Night until this form is completed even if he/she has purchased a ticket - please complete this form even if your student is already 18 years old. Please email encinalgradnight2020@gmail.com with any questions.

This form must be completed before May 31, 2020. PLEASE NOTE THERE ARE NO REFUNDS FOR ANY REASON ONCE YOU HAVE PURCHASED A GRAD NIGHT TICKET.
Email *
Student Full Name: *
Student email: *
Student cell number *
Student Address: *
Parent/Guardian Full Name: *
Parent/Guardian Address: *
Parent/Guardian cell number: *
Parent/Guardian Email: *
I confirm my student is a current senior at Encinal - this event is for Encinal Seniors ONLY *
TO BE COMPLETED BY PARENT/GUARDIAN *
I confirm that my student is in good physical condition and has not had any serious illness or surgery since their last health examination. I give my permission for my student to receive emergency medical or surgical treatment and to be hospitalized if necessary. I understand that every attempt will be made to contact me ,or the second person below, before taking this action.
TO BE COMPLETED BY PARENT/GUARDIAN *
I acknowledge that I am responsible for the costs of emergency services.
Insurance Details: *
Company
Policy Number: *
Allergies/Medical Issues: *
If none - write "none"
Secondary Emergency Contact Name: *
This person will be contacted during an emergency if primary contact is not available.
Relationship to Student: *
Secondary Emergency Contact Cell number: *
Secondary Emergency Email: *
Secondary Emergency Contact Address: *
Waiver (1): (1), (2) & (3) MUST BE COMPLETED BY A PARENT/GUARDIAN *
I acknowledge that my student can not take any backpack, carry bags or drink bottles of any kind to Scandia. If your student brings a bag/backpack they will not be allowed on the bus. Adult chaperones are not responsible for any student's belongings.
Waiver (2): *
I acknowledge that my student will be released by the parent chaperones once the buses return to the Encinal campus at approximately 1:00am on June 5, 2020. It is the parent's responsibility to ensure their student makes it home safely.
Waiver (3) Code of Conduct: *
I understand that my student must behave in a respectful manner conducive to modeling good behavior. I acknowledge that my student must follow AUSD school behavioral policies. If my student fails to observe the above the parent/guardian will be called and will be required to pick up their student from Scandia.
I acknowledge there are not refunds for my student's Grad Night ticket *
Students must be eligible to graduate to attend Grad Night. *
Form completed by: *
Please provide the full name of the parent or guardian that completed this form, as your e-signature.
Relationship to student: *
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