Grad Package - COVER - St Paul's High School

St Paul’s High SchoolGuest Information GUEST OF: _________________________(GRADUAND’S SURNAME, FIRST NAME)Guest Surname ___________________________ Guest First Name____________________Birth date of Guest __________ / __________ / __________MM DD YYYYage as of June 21, 2013 __________________________Guest Telephonehome _________________________________ cell ____________________________Manitoba Health Numbers (9 digit) ___ ___ ___ ___ ___ ___ ___ ___ ___ (6 digit) ___ ___ ___ ___ ___ ___Physician’s Name ________________________________ Phone__________________________Health problems or allergies about which the organizers should be aware of_______________________________________________________________________________________________________________________________________________________________________________Signature of Guests’ Parent or Guardian _________________________________________________________Parent’s or Guardian’s phone number on the evening of Safe Grad _______________________________________Pick Up ConsentI/We the undersigned have read and understand the attached Safe Grad Information & Regulations 2013. I/We understandthat attendance at Safe Grad is conditional upon our agreement to be bound by the Safe Grad rules and to provide theinformation requested below.I/We agree to take all precautions to ensure that we are in a position to provide a safe ride home for the above‐namedguest. I/We will be at the Winnipeg Convention Centre, 375 York Ave no later than 3:30 AM to pick up the above‐named.Should this guest decide to go home at an earlier time, I/we agree to come when called by a supervisor.The persons identified below as the driver and the alternate driver currently holds a valid Manitoba Driver’s License (not alearner’s permit). I/We understand that the driver WILL be asked to show photo ID when picking up the guest. The guestwill be released only to the person or persons signed below. Please be sure that these persons are available on Saturday,22 June, at 3:30 AM.Driver # 1 InformationName of driver picking up Guest ________________________________________________________________Phone number home _________________________________cell _____________________________Relationship to Guest________________________________________________________________________Signature of Driver # 1 ____________________________________________________________________Driver # 2 InformationName of alternate driver picking up Guest _______________________________________________________Phone number home __________________________________cell _____________________________Relationship to Guest __________________________________________________________________________Signature of Driver # 2 _________________________________________________________________________________________________________________________________________________________St Paul’s High School ● Guest Information 2013 ● 29 April 2013 ● www.stpauls.mb.ca