Registration form - Unionville High School - Unionville-Chadds Ford ...
Registration form - Unionville High School - Unionville-Chadds Ford ...
Registration form - Unionville High School - Unionville-Chadds Ford ...
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UHS AFTER PROM REGISTRATION FORM<br />
MAY 18, 2013 * 11:00 PM TO 5:00 AM<br />
ALL 11 th and 12 th grade <strong>Unionville</strong> <strong>High</strong> <strong>School</strong> students are invited to attend the FREE After Prom Party. It is not necessary to<br />
attend the Prom to go to the After Prom. Questions-‐Contact: Patty Denton – 610-‐742-‐6575 or padenton8@gmail.com. A<br />
list of students registered for the After Prom will be posted on the UHS website under PTO.<br />
Return completed and signed registration and consent <strong>form</strong>s by May 3rd<br />
MAIL: Patty Denton, 624 E Hillendale Road, <strong>Chadds</strong> <strong>Ford</strong>, PA 19317<br />
HAND DELIVERY: To box labeled UHS AFTER PROM in the UHS Main Office<br />
My son/daughter __________________________________________WILL attend the After Prom Party<br />
Grade: __________ His/Her cell phone _________________________________<br />
Parents’ e-‐mail address_____________________________________________________________________<br />
Parents’ Home phone ________________________ Parents’ Cell phone________________________<br />
Parent’s signature ____________________________________ Date _____________________________<br />
*Arrival time for the After Prom Party is between 11:00 pm and midnight. Parents will be contacted by phone if students do<br />
not sign in. Please provide phone numbers where you can be reached during the night.<br />
Departure will be at 5:00 am. We encourage parents to pick their students up at 5:00 am as they will be tired.<br />
*UHS Juniors or Seniors bringing a prom GUEST who is not a UHS 11 th or 12 th grader, or not a UHS student must complete the<br />
following in<strong>form</strong>ation:<br />
Guest’s name ___________________________________________________________________________<br />
<strong>School</strong> _________________________________ Grade ______ Cell phone __________________________<br />
Guest’s Parent’s e-‐mail address_____________________________________________________________<br />
Guest’s Home phone ____________________ Guest’s Parent’s Cell phone______________________<br />
SCOTT HONDA CAR GIVE-‐AWAY 2013-‐CONSENT FORM<br />
A car will be raffled off to one lucky student during the After Prom Party! Only UHS Juniors and Seniors attending the After<br />
Prom Party are eligible and ** MUST BE PRESENT TO WIN ** Please note that the winner of the car and their parents are<br />
responsible for paying any monies, including but not limited to, taxes, title, insurance etc. incurred as a result of winning the<br />
car. The car will be available for pick up the week following the 2013 After Prom Party.<br />
I hereby give my consent for __________________________________ to be entered to win the Car donated by Scott Honda at<br />
the 2013 UHS After Prom Party on May 18, 2013.<br />
Parent/Guardian __________________________________________ Date _______________<br />
Photo Release: The 2013 After Prom will feature pictures of students from the Prom and After Prom. The pictures may be<br />
posted to the UHS Website, Snapfish or Facebook. I hereby give my consent to The After Prom Committee to display images of<br />
my child _____________________________at the UHS Prom and the After Prom Party on May 18, 2013.<br />
Parent/Guardian __________________________________________ Date _______________<br />
*******************************Please fill out other side of this <strong>form</strong>
EARLY DEPARTURE PROCEDURES FOR STUDENTS WHO LEAVE THE 2013 AFTER PROM PARTY PRIOR TO 5 AM<br />
*Parents: Signature is required on all sections on this page even if your child does not plan to<br />
leave early.*<br />
The intent of the After Prom Party is to keep students SAFE AND OFF THE ROADS on Prom night. The party is a<br />
school-‐sanctioned event that runs from 11 PM on 5/18/13 until 5 AM on 5/19/13. The After Prom Planning<br />
Volunteers strongly encourage ALL STUDENTS TO STAY UNTIL 5 AM.<br />
POLICY, PROCEDURE & LIABILITY RELEASE for students, their date and parent(s):<br />
I understand the purpose of the After Prom is to keep students safe and by my signature below, I agree that I (or my<br />
child) will remain at the After Prom until the departure time of 5 AM. It is up to the parents, students and their<br />
dates to arrange for their safe return home from <strong>Unionville</strong> <strong>High</strong> <strong>School</strong> at 5 AM. The PTO After Prom Committee<br />
strongly urges parents to pick up their students.<br />
Neither the <strong>Unionville</strong> <strong>High</strong> <strong>School</strong> PTO, the <strong>Unionville</strong> <strong>Chadds</strong> <strong>Ford</strong> <strong>School</strong> District nor any individual associated with<br />
either organization shall be liable for any claim of any sort whatsoever that arises out of anyone either attending or<br />
traveling to or from the 2013 <strong>Unionville</strong> <strong>High</strong> <strong>School</strong> After Prom Party.<br />
I understand the emergency exception policy as described below and agree to abide by it.<br />
_______________________/____________________/_____________________/___________________<br />
Parent/Guardian’s signature of UHS Student) Print Name UHS Student’s signature Print Name<br />
_______________________/____________________/_____________________/___________________<br />
Parent/Guardian’s signature Print Name Date’s signature Print Name<br />
(of Student’s date if under 18)<br />
***************After Prom Arrival/Dismissal Procedures***************<br />
**Parents: You must initial each item to confirm your understanding of the policies**<br />
In case of illness, or any other unforeseen issue at the 2013 After Prom Party, which requires the After Prom nurse<br />
or security to request early student release, or if you have pre-‐arranged early dismissal, I, as parent understand the<br />
following:<br />
• Students are to arrive by 12a.m. _____<br />
• Unless previous arrangements with the parents/guardians are made, students will be dismissed at 5a.m. ______<br />
• If a student needs to leave early their parent/guardian is to transport him/her home, pre-‐arranged early dismissals must be<br />
made with After Prom registration padenton8@gmail.com. ______<br />
• Students leaving early are not eligible to win any prizes including the Scott Honda car. ______<br />
• Parents will need to bring a valid <strong>form</strong> of identification to be presented for identity verification to the After Prom Security<br />
before their student will be released to their care_____<br />
• Parent must come in to <strong>Unionville</strong> <strong>High</strong> <strong>School</strong> and sign their child out. No student will be released to the care of an older<br />
sibling or any other adult. The pickup must be by the parent only. _____<br />
• Only the parent of my child’s date is permitted to sign my child’s date out. Their parent must come to sign them out,<br />
regardless of age. _____<br />
• I understand that if my child leaves early, he or she will not be readmitted to the 2013 After Prom Party. _____<br />
• It is strongly suggested that a parent/guardian transport all students home from the after prom party at 5 am ______<br />
(the students will be very tired and studies show that driving tired is just as dangerous as driving while intoxicated, exactly<br />
what the after prom is trying to avoid)<br />
This Early Release Procedures applies individually and separately to the UHS Student and their date.<br />
Parent/Guardian __________________________________________ Date _______________
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