Registration Form - WHS Senior Sober Grad Night

Class of 2024 - Sober Grad Night Registration Form

As a member of the Whitney High School graduating class of 2024, your son/daughter is eligible to attend our Sober Grad Night; a safe, sober and drug free graduation celebration. **This event is planned and run by parents of WHS students and is not a Whitney High School function**

1Student and Parent Information

2Emergency Contact Information

3Rules and Information

4Sober Grad Night Release

5Rocklin USD Waiver

Student Information

Student Last Name *

Last Name

Student First Name *

First Name

Student Cell Number *

Student E-mail *

Parent Information

Parent Last Name *

Last Name

Parent First Name *

First Name

Address *

Address Line 1

City

State

Zip Code

Parent Home Phone

Parent Cell Number *

Parent Email *

Rules and Information

WHS Sober Grad Night is a “Zero Tolerance” event. Any graduate, regardless of the age, choosing unacceptable behavior will have their parent called and will be picked up by the parent and/or counseled by local law enforcement. Only graduating seniors from Whitney High School can attend. STUDENT ID IS REQUIRED AT ENTRY. Graduates must check-in at the venue between 10:30pm and 11:30pm to be admitted. We will do our best to notify parents if a graduate on the list does not check-in. Graduates (regardless of age) will NOT be allowed out of the event boundaries until 5am unless accompanied by a parent. Our volunteers will do our best to ensure that students do not exit or enter during the event until 4:30am but will not be held liable if that happens. Graduates will not be permitted to attend this event unless a parent/guardian signs the waiver(s) and emergency information as part of registration. The signatures specify that graduate and parent/guardian approve and agree to all the rules listed. Bags/belongings will be searched and bags will be required to be left at bag check. The graduates may access their bag with help of a volunteer throughout the night. NO ALCOHOL, DRUGS, TOBACCO, WEAPONS, LIQUIDS OR FOOD on the premises. All open containers will be confiscated; please leave perfumes, hand sanitizer, water bottles, etc. in your car. Photos may be taken by the volunteer team at the event and used in promotional materials and/or shared with the attendees. Finally, we strongly recommend that a student does NOT drive themselves to and from the event. Driving exhausted can be compared with driving drunk.

Rules and Information, Student Electronic Signature (copy) *

Please type your First and Last Name

Student Rules and Information Acknowledgement *

I the Student understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Rules and Information statement. *

Rules and Information, Parent/ Guardian Electronic Signature *

Please type your First and Last Name

Parent Rules and Information Acknowledgement *

I the Parent / Guardian understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Rules and Information statement. *

Sober Grad Night Release

LIABILITY RELEASE: . I understand that the Whitney High School Sober Grad Night Event is conducted by Whitney High School Sober Grad Night through its committee and volunteers. In consideration for the services provided through the Sober Grad Night Event, I hereby agree to release and discharge all parties referred to as WHS Sober Grad Night as follows: 1. I voluntarily choose to allow my child to participate regardless of the risks in participating in the WHS Sober Grad Night Event. I understand and acknowledge that the Event includes activities with a risk of injury, including the risk of physical injury or death. I expressly agree to accept and assume all risks arising from or relating to my child’s participation in the Event, including the risk of acts or omissions by WHS Sober Grad Night constituting ordinary or gross negligence. I assume these risks both on my own behalf as parent or legal guardian of the child I am registering and on behalf of my child’s own rights. 2. I as the parent of the attendee, as well as the attendee, acknowledge the contagious and evolving nature of COVID-19 and voluntarily assume the risk that myself/my child may be exposed to the virus and become affected as a result. I understand the risk of my child becoming infected may impact the other attendees of the event, and possibly my family. I agree to assume all of the foregoing risks and accept sole responsibility for any expense, liability, illness, injury, disability or death related to contracting the virus while attending the event hosted by WHS Sober Grad Night. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Whitney High School Sober Grad Night from all claims, demands, or causes of action, brought by any person or entity, arising from or relating to my child’s participation in the Event, including any claims that allege acts or omissions by WHS Sober Grad Night constituting ordinary or gross negligence. 4. I acknowledge that this agreement extends not only to any rights I may have as the parent of my child, but to my child’s own rights as well. This release form is completed and signed of my own free will with the purpose of granting my child/myself to participate in the Event.

Sober Grad Night Release, Student Electronic Signature *

Please type your First and Last Name

Parent/Guardian Electronic Signature *

Please type your First and Last Name

Agree to waiver *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Sober Grad Night Release statement. *

ASSUMPTION OF RISK AND WAIVER OF LIABILITY FOR TRANSPORTATION AND AGREEMENT TO ABIDE BY ROCKLIN UNIFIED SCHOOL DISTRICT’S COVID-19 PROTOCOLS

Activity: Sober Grad Night

School Name: Whitney High School

The novel coronavirus (or COVID-19) has created a pandemic resulting in a State of Emergency in California. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and health officers have required or recommended social distancing and, in many instances, have prohibited or significantly limited the congregation of groups of people.

Rocklin Unified School District (RUSD)is complying with guidance and taking reasonable steps to mitigate the risk of spreading COVID-19. This risk; however, cannot be completely eliminated and RUSD cannot guarantee that you and/or your student(s) will not become infected with COVID-19. Further, participating in the RUSD activities may involve transportation by bus or otherwise could increase your and/or your student(s)’s risk of contracting COVID-19. For the safety of our staff, students, parents, and other visitors, RUSD requires all persons participating in its activities during this pandemic to acknowledge an assumption of the risk, waive (i.e. release) liability, and agree to abide by our COVID-19 protocols, as follows:

1. I am the parent and/or legal guardian of the above-named student(s) and I request that they be allowed to participate in the district’s activity and give my permission to do so.

2. Assumption of Risk. By signing this agreement, I understand and acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my student(s) may be exposed to or infected by COVID-19 by participating in the school district’s activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 as a participant in such activity and/or transportation may result from the actions, omissions, or negligence of myself and others, including, but not limited to, other participants or RUSD officials, employees, volunteers, and/or representatives. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any harm, loss, or injury to my student(s) (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense of any kind, that I, or, if applicable, my student(s)/child(ren), may experience or incur in connection with the above activity. (“Claims”).

3. Waiver of Liability. In consideration for the District allowing my student(s) to participate in the district’s activity and/or transportation service, I, on behalf of my student(s), hereby release, Board Members: Dereck Counter • Rachelle Price • Rick Miller • Julie Hupp • Tiffany Saathoff covenant not to sue, discharge, and hold harmless the District, and any officials, employees, volunteers, and/or representatives thereof (“Releasees”), of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence or other conduct of RUSD, its officials, employees, volunteers, agents and/or representatives, whether a COVID-19 infection occurs before, during, or after use of the district’s transportation services.

4. Agreement to Abide by COVID-19 Protocols. I agree that my student(s) will not enter District grounds, facilities, buses or any other vehicles if my student(s) is feeling ill, which includes, but is not limited to, the following symptoms: fever, cough, difficulty breathing, shortness of breath, chest pain, and/or bluish lips or face. I understand and acknowledge my student(s) may be denied entrance or admittance if the District determines that my student(s) are showing any such symptoms. I warrant and represent that I am not aware of any medical condition of my student(s) which would render it inappropriate for them to participate in the district’s activity and/or transportation services. I agree to abide by all COVID-19 guidelines and other COVID19-related policies and procedures, which may change over time as circumstances change. This may include hand washing requirements and temperature checks for my student(s). I agree to instruct my student(s) to practice good hygiene etiquette such as sneezing into their elbow, utilizing tissues, and avoid touching their eyes, nose, and mouth. I understand and acknowledge that my failure to ensure that my student(s) abides by this agreement may result in my student(s) being removed from the activity and/or transportation.

I HAVE READ THIS ASSUMPTION OF RISK AND WAIVER OF LIABILITY AND AGREEMENT TO ABIDE BY ROCKLIN UNIFIED SCHOOL DISTRICT’S, COVID-19 PROTOCOLS, AND FULLY UNDERSTAND ITS TERMS.

By typing your name below, you are aware that it is an electronic signature and that it represents your consent as a parent/guardian and student.

RUSD Release, Student Electronic Signature *

Please type your First and Last Name

RUSD Release Parent/Guardian Electronic Signature *

This is to certify that I, as parent/guardian, with legal responsibility for the above-named student(s), have read and explained the provisions in this waiver/release to my student including the risks of presence and participation and my student(s) personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my student understands and accepts these risks and responsibilities. I, my spouse, and student(s) do consent and agree to their release provided above for all the Releases, and myself, my spouse, and student(s) do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor student(s) presence and/or participation in the district’s activity and/or transportation services as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

Payment Type *

Pay online via PayPal or pay by check, please make it out to “WHS Sober Grad Night” and mail your payment to: Whitney High School Attn: Sober Grad Night 701 Wildcat Blvd. Rocklin, CA 95765

Click the "Register" button to save your registration.

Message