WSHS Graduation Ceremonies on Sunday May 24th will be followed by a School Tradition:
PROJECT GRADUATION: an all night Drug-Free and Alchohol-Free Senior Lock-in Held at
WellWorx Sporting Clubs
6161 Shelby Oaks Drive
Memphis, TN
Hours: 11:00pm - 5:00am
All students must arrive no later than midnight
We will lock the doors at midnight and no one will be allowed to enter or exit the building until 5:00am
If your child has purchased a ticket and does not arrive by midnight, his/her parent will be called by one of our parent
chaperones
When you purchase your ticket, you must also turn in 1) A WellworX Release form, 2) A WellWorx Rules Form and
3) A WSHS Project Graduation agreement, signed by a parent or guardian. If your student purchases a ticket during
one of our lunch sales times or at Graduation rehearsal, he/she will need to show a valid student ID or Driver’s
license in addition to turning in all of these applicable forms. Only White Station High School Graduating Seniors
may purchase tickets and attend this graduation event.
TICKETS WILL NOT BE SOLD AT THE DOOR – YOU OR YOUR STUDENT MUST PURCHASE A TICKET
DURING ONE OF THE PRE-DESIGNATED TIMES:
Tickets are currently on sale at a discounted price of $15.00 per student until April 20th
You can download the following three required forms and mail them signed with your check to:
Pat Lichterman
6181 Malloch Drive
Memphis, TN 38119-6326
Beginning Wednesday, April 22nd, your student can purchase tickets during lunch for $18.00
Tickets will be on sale on the following Dates:
Wednesday, April 22nd, Thursday, April 23rd, Friday, April 24th,
Wednesday, April 29th, Thursday, April 30th,
Wednesday, May 6th
We will have these forms available at the ticket sales table, but you can help by sending these completed forms with
your senior
We will have a final ticket sales opportunity at Graduation Rehearsal when tickets will cost $20.00
This promises to be a great Celebration! If you have questions about this event or would like to chaperone, please
contact the event chairs
Lynn Eisenstatt at 682-7975 ( jerrye19@bellsouth.net ) or Barbara Newman at 374-9134 ( barbara@bsholom.org ).
**THE FOLLOWING THREE FORMS MUST BE TURNED IN TO BUY A TICKET**
1
PROJECT GRADUATION – 2009
EMERGENCY INFORMATION FORM
Name_________________________________________________________Phone__________________
(For Door Prizes) Male_______Female_______
Address______________________________________________________________________________
Parent/Legal Guardian__________________________________________________________________
Address______________________________________________________________________________
Emergency Contact Person_____________________
(May 24th, 11:00 p.m. – May 25th, 5:00 a.m.)
Phone__________________________________
Please list any medications you take regularly._______________________________________________
Please describe any medical condition(s) that a doctor would need to know about in an emergency
situation._____________________________________________________________________________
White Station High School
PROJECT GRADUATION AGREEMENT
Understanding that consumption of alcoholic beverages or use of drugs is in violation of
Tennessee Law, I agree not to consume or bring any substance in violation of that law. I also understand
and agree that my personal effects may be searched.
Print Name___________________________________________________________________________
Address______________________________________________________________________________
Phone (home) _________________________________ (cell) ___________________________________
* Student Signature___________________________________Date_____________________________
PROJECT GRADUATION RELEASE
Participant shall release White Station High School, its employees, Partners in Education (PIE), and the
Memphis City School System from any such claims or actions for damages, costs or reimbursements that
may result from this event.
_______________________________
PRINT NAME OF STUDENT
_________________________________
*SIGNATURE OF STUDENT/DATE
____________________________________
PRINT NAME OF ADULT GUARDIAN
_______________________________________
**SIGNATURE OF ADULT GUARDIAN/DATE
2
WellWorX Sporting Clubs Guest Waiver and Ongoing Release Form
Have you ever been a guest at WellWorX Sporting Clubs? ___ YES
___ NO
In consideration of being permitted to enter WellWorX for any purpose, including, but not limited to observation, use of
the facility or equipment or participation in any way, the undersigned
___________________________ (print name) hereby agrees and represents that he or she
has, or immediately upon entering shall, inspect such premised and facilities. It is further
warranted that such entry in WellWorX for observation, participation or use of any facilities or
equipment constitutes an acknowledgement that such premises and all facilities and equipment
thereon have been inspected and that the undersigned finds and accepts same as being safe
and reasonably suited for the purposes of such observation or use. In further consideration of
being permitted to enter WellWorX for any purposes, the undersigned hereby agrees to the
following:
The undersigned hereby releases, waives, discharges and covenants not to sue WellWorX
Sporting Clubs, the corporate owners, and any affiliated companies or owners and/or their
agents and employees (hereinafter referred to as “releasees”) for any loss or damage, and any
claim or demands therefore on account of injury to the person or property or resulting in death of
the undersigned, whether caused by the negligence of the releasees or otherwise, while the
undersigned is in, upon, or about the premises or any facilities or equipment, therein.
The undersigned hereby agrees to indemnify and save and hold harmless the releasees, and
each of them, from any loss, liability, damage or cost they may incur due to the presence of the
undersigned in, upon or about WellWorX premises or in any way observing or using any
facilities or equipment of WellWorX whether caused by negligence of the releasees or
otherwise.
The undersigned further expressly agrees that the foregoing release, waiver and indemnity
agreement is intended to be as broad and inclusive as permitted by law and that if any portion
thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal
force and effect.
The undersigned has read and voluntarily signs this release and waiver of liability and indemnity
agreement, and further agrees that no oral representations, statements or inducements apart
from the foregoing written agreement have been made. I have read and I understand all
portions of this release.
Signature __________________________________ Age: ____ Date ___/___/___
Home Phone: ____________________
Check in time: ____________
Guest of or Referred by: _______________________________________
IF UNDER AGE 18, A PARENT OR GUARDIAN MUST SIGN BELOW
In consideration of this minor being allowed to participate in activity(ies) at WellWorX, I
personally agree to all of the above terms on his or her behalf.
Parent or Guardian Signature _____________________________ Date ___/___/___
3
WellWorX Lock-In Rules
WellWorX Lock-in Rules
Please observe the following rules in order to make your lock-in safe and
enjoyable.
1.
2.
3.
4.
5.
6,
7.
8.
9.
10.
11.
12.
13.
14.
15.
Stay out from behind the desks, front and back.
Use only the phone in the banquet room
WellWorX will not issue lockers for the lock-in and will not be
held responsible for lost or stolen items.
The strength floor is strictly off limits to everyone.
The cardio floor is strictly off limits to everyone.
The gymnastics floor is off limits and armed with an alarm.
Tanning rooms are off limits.
There will be no Black soled shoes allowed on the Tennis Courts,
Basketball Court or Racquetball Courts.
You must provide your own Tennis and Racquetball equipment.
No re-entry will be allowed for any reason.
No hanging on any equipment, including but not limited to
Basketball rims and Tennis nets.
If the presence of alcohol or drugs is suspected, WellWorX will
call the police and close the function down.
If the Off Limits areas are breached WellWorX will close the
function down.
If the gymnastics area is breached WellWorX will call the police
and press trespassing charges on the offenders. This area is
monitored by alarm and camera.
Pool usage is for the set hours only.
I have read, understand and agree to abide by the above rules.
__________________________________________________________________
White Station High School Student
Date
__________________________________________________________________
****THESE FORMS MUST BE TURNED IN TO BUY A TICKET****