PONDEROSA HIGH SCHOOL
PROM NIGHT AFTER PARTY WAIVER – April 18-19, 2015
PLEASE PRINT ALL INFORMATION
Name:__________________________________________________ Grade:_______ Age:________ Phone:_____________________
I am a PHS student:_________ I am a guest of:______________________________________________ Grade:____________
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If you are a PHS junior or senior, you are not considered a guest. PHS sophomores & freshmen are
considered guests.
Every activity is included in the cost: $25.00
ALL students and guests must have a signed waiver, even if they attend a different school, before
they will be sold a ticket.
PLEASE RETURN THIS FORM TO THE TICKET SALES DESK OR THE MAIN OFFICE BY April 17
at 1:30 PM.
I, the undersigned parent or legal guardian of ___________________________________________, hereby grant permission for my student to
participate in the Prom Night After Party (“Party”) for PHS juniors and seniors and their guests, which is scheduled for April
18th/19th from 11:30pm to 4:00am. This event will be held at the Parker Field House, 18700 E Plaza Dr, Parker, CO 80134.
This event will include, but is not limited to, the following activities: large inflatable games, carnival games, raffle prizes,
contests, casino games, photos, and food. I understand that it is the school’s and district’s desire to provide an enjoyable and
safe environment for the students following the prom.
I understand that my student’s participation in the Party is entirely voluntary and that my student’s participation potentially
involves risks and obligations that are impossible to predict but which are beyond the scope of those normally associated with
traditional school functions. These risks include, but are not limited to, the loss or damage to personal property and the risk of
sickness, personal injury or death while participating in the Party. In the event of injury, I do hereby consent to any emergency
medical treatment rendered to my student under the supervision of professional health care providers. My student has the
following allergies (please list all):
_______________________________________________________________________________________________________________________________________
**I understand that students will not be admitted after 1:00am. Further, students will be “locked
in” until 4:00am unless I sign below giving express written consent.
My student has permission to leave at any time_____________________________________________________
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If a student leaves the facility unescorted, that student will not be allowed to return.
Escorts will be provided if a student needs to go to his/her car.
I understand that due to circumstances beyond the District’s control, the District cannot warranty or guarantee that
the parent or legal guardian of every student attempting to leave will be contacted. The student will be signed out and
a time recorded as to when they left.
 I give permission for District personnel or authorized volunteers to search any tote bag, duffle bag, etc. that is in my
student’s possession upon entering the facility.
I hereby release and hold harmless the District, it’s director, officers, agents, employees, teachers and authorized volunteers
from any and all liability, liens, claims, demands, actions or cases of action, whatsoever arising from my student’s participation
in any aspect of the Party.
If you have any questions, please call Paige Zahorik at 303-887-7389
Parent/Guardian Contact Information (home)__________________________ (cell)___________________________
Parent/Guardian Signature_______________________________________________________ date ______________________
Student Signature________________________________________________ Phone _________________________________
* TICKETS PURCHASED AT THE DOOR MUST BE ACCOMPANIED BY A SIGNED WAIVER*