Harmony Public Schools
Where Excellence Is Our Standard
Event Name: Harmony Public Schools’ “College Acceptance Day Pep Rally 2014”
Date of Event: May 23rd, 2014 (11:30 a.m. – 2:30 p.m.)
Permission Slips Due: May 16, 2014
Harmony Public Schools has arranged for all 12th grade students to attend the Annual Harmony Public Schools “College Acceptance Day Pep
Rally”. This exciting event will take place on May 23rd at the Rice University Tudor-Field house. All Graduating 12th grade students will have the
opportunity to announce for the first time publically which College they plan on attending in the fall. The seniors will celebrate their College
attendance plans with over 4,000 fellow Harmony students through various forms of entertainment (music, song, dance, cheer, speakers etc). All
Graduating 12th grade Student Parent(s) should plan to attend this milestone event. There will be VIP seating for all Senior Parents attending this
event. Lunch will be provided for Graduating Senior Students only. Senior students will be allowed to leave the Rice Campus after the event
with their Parent (s) (prior notification required below). Senior Students should wear dress/business attire consistent
with their respective campus’s dress code (button down dress shirts with slacks, no jeans; dresses and
skirts, no miniskirts,(fingertip length) low-cut blouses or spaghetti strap dresses). Senior Students will leave the
school at 8:00 a.m. and plan to return by 2:45pm. Please be aware that due to the large number of students participating in this event, the buses
may arrive back to campus later than scheduled.
Student Name: ______________________________________
Grade/Section: ______________
I, _________________________________ (student’s name) pledge to abide by all district policies of the Harmony Public
Schools District handbook. I understand that I am governed by the same rules on this trip as when I am at school. Any failure to
adhere to these policies will result in disciplinary action.
(Student Signature)
Grade/S ection:
We (I), the parent (s)/guardian of ________________________________________ understands and agree that the trip is a school
sponsored activity and function. This release is intended to cover all injuries of every name, type, kind or nature, and personal
property damage, if any, which may be sustained or suffered from any cause connected with or arising out of, or from
participation in the listed events. I understand I am responsible for transportation costs if my child is required to return home for
disciplinary measures.
This is to certify that my child has my permission to go on the field trip listed with this group. By signing this form parent(s)
give(s) consent to his/her child to take the transportation provided by school, teacher, or another parent. Means of transportation
could be any public, rental or private vehicles driven by an adult. I also give permission for my child to be photographed or
(Parent Signature)
My Graduating Senior will be leaving at the conclusion of this event with either his/her Parent (s) or my designated adult
guardian chaperon.
(Parent Signature)
Print Name
I and/or my Spouse with also be attending this event:
____Yes ____No
Number of Guests Attending _____ (Due to limited seating Two Guests per Senior Please)
Emergency Medical Release
Home Phone:_________________ Work Phone:________________ Cell Phone:_____________
Emergency Contact/Phone:________________________________________________________
Insurance Company/Policy/Group #_______________________________________________
Doctor’s Name/Number_________________________________________________________
Blood Type:___________________Known Allergies:__________________________________
Any Additional Medical Information:_______________________________________________
In case of emergency, I authorize emergency treatment to be administered if I cannot be contacted.
Parent/Guardian Signature