STUDENT ID______

Name of Medical Insurance Carrier ________________________________ Policy Number _______________________________

I have read the rules for attendance and agree to behavior consistent with them. I understand and agree to the policies and provisions of my participation in Grad Nite 2008 at Kennedy High School. I agree not to carry into the party premises any materials or liquids which will affect my behavior and/or will have a detrimental effect on others’ enjoyment of the evening. I also understand that once I enter the facility, I may not leave unless my parent or guardian personally arrives at the Grad Nite location to sign me out. (This must be pre-arranged).

Liability Release: I agree that the Kennedy Grad Nite Committee, Kennedy HS and/or the AUHSD will not be held liable for injury or illness incurred while in attendance at Grad Nite. In case if injury, and if unable to reach parents by phone, I understand that Grad Nite chaperones and/or school employees will seek medical assistance as deemed necessary (a parent must sign medical liability regardless of student’s age). We recognize the advantage of Grad Nite and its purpose of saving lives by providing an alcohol-free and drug-free environment for our graduating seniors. With this understanding, we hereby voluntarily provide the Kennedy Grad Nite Committee, Kennedy HS and/or the AUHSD with this release of all claims and hold harmless agreement.

Note: If you need to submit this on a non-ticket sale day, take to the Student Services Office.