THIS COMPLETED FORM IS REQUIRED FOR GRAD NITE 2015 PARTICIPATION Olympian High School - Grad Nite, May 29, 2015 PERMISSION SLIP FORM and MEDICAL RELEASE FORM This special night is an all-night alcohol and drug free celebration (from 3 p.m. to 2 a.m.) at Disneyland and California Adventure Park for all graduating OHS seniors. On Friday, May 29th, buses will depart promptly from Olympian High School at 1:30 p.m. and depart Disneyland at 2:15 a.m. Seniors must attend school from periods 1-4 on Friday, May 29th in order to be eligible to attend Grad Nite. Any senior missing periods 1-4 on Grad Nite day will not be permitted to attend Grad Nite and the ticket is not refundable. If you are allowing your student to walk home at 5am Saturday morning when we return from Grad Nite, you must contact Ms. Pentz-Lopez in writing at [email protected] The price of your ticket includes the following:    

Entry into Disneyland and California Adventure Parks (Park Hopper) Unlimited use of attractions (except arcades) Unlimited use of all entertainment and dancing facilities Bus transportation to and from Disneyland

Buses will be assigned the week of March 16-20, 2015 at lunch in room 704. Seniors can sign up for the bus of their choice ONLY if they have purchased their ticket by March 13, 2015, turned in this permission slip, and the parent agreement & release of liability form. Students who purchase their Grad Nite ticket after March 13, 2015 will be automatically placed on a bus by the school. In keeping with the magical atmosphere of the evening, you MUST adhere to the following dress code and rules. Disneyland has established this dress code and those dressed inappropriately will NOT be admitted to the park. Disneyland Security has the right to refuse admission to anyone they deem not appropriately dressed for the event. Chaperones must also abide by the dress code. In addition, student driven vehicles are not permitted. Students will only be admitted if they attend Grad Nite on the chartered bus and with their school. All students must have a school ID before boarding the bus at OHS and entering Disneyland. Friday, May 29, 2015 Schedule for seniors attending Grad Nite: 1st period: 2nd period: Nutrition Break 3rd period: 4th period: Seniors Released Meet buses at OHS (Behind the school on Rock Mountain Road) Buses leave from OHS Leave Disneyland Pick up at OHS (Front Parking Lot)

7:30am – 8:27am 8:34am – 9:37am 9:37am – 9:47am 9:54am – 10:51am 10:58am – 11:55am 12:02 pm – 1:00pm 1:00pm 1:30 pm*** 2:15am Approx. 5:00am

*** Buses leave promptly at 1:30pm from OHS; students will not be refunded if they miss the bus.

Below is a list of items NOT allowed in the park or on the bus:                 

Any clothing affiliated with a school, sports team, group, club, etc. (i.e. letterman jackets, clothing with school logos, etc.) Clothing not in good repair (torn jeans, shirts, etc.). Jeans are OK as long as they are not ripped or torn. Extremely revealing clothing (i.e. bathing suit tops or bottoms, see-through clothing, etc.) Hats (Disneyland merchandise acceptable) and other head attire, including beanies and wigs All backpacks, briefcases, hip packs, camera bags, tote bags, and oversized purses larger than 81/2" x 11" (size of a piece of paper). Cameras, cell phones, and pagers are OK. Shoes with skate wheels are not allowed. Tennis shoes and sandals are OK. Weapons, knives, chemical irritants of any kind, laser pointers Prescription medication (inhalers are ok) Over-the-counter medications Tobacco products (cigarettes, cigars, chewing tobacco, snuff, nicotine mints, electric cigarettes, etc.) and related materials (lighters, matches, pipes, etc.) Alcohol or any controlled substance Bandanas (either worn or hanging from belt loops/pockets etc.) Glass containers and/or fluids of any kind. This includes water, any drinks and perfumes Snack items include but are not limited to gum/mints/candy (no candy containers) Spiked style jewelry or belts Aerosol cans/bottles

Please see the school website for a detailed list of Disney Grad Nite Dress Code Guidelines and Prohibited Items. ***Disney will deny admission if guidelines are not followed STUDENT/PARENT INFORMATION STUDENT’S NAME ____________________________________________________________ SCHOOL ID# _______________________ LAST

FIRST

PARENT/GUARDIAN NAME _________________________________________ EMAIL: ____________________________________ LAST

FIRST

ADDRESS _____________________________________________________________________________________________________________ STREET

CITY

ZIP

PARENT/GUARDIAN PHONE______________________________/__________________________/_____________________________ HOME

WORK

CELL

MEDICAL INFORMATION In case of emergency, I hereby authorize my child to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician). PARENT/GUARDIAN SIGNATURE_______________________________________Medical Insurance yes______no_______ If yes, name & policy # ______________________________________ Health Insurance Name: __________________________ Primary Care Physician_________________________________________

Phone # ________________________

Consent to give over the counter medications Yes_______ No_______ Allergies, Medical Conditions or Medication taken __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________