Pace High School Universal’s Grad Bash ’15 Parent Permission Slip




Дата канвертавання27.04.2016
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Pace High School Universal’s Grad Bash ’15 Parent Permission Slip
I / We hereby grant permission for ___________________________________________ to attend UNIVERSAL STUDIOS PRE-PARTY AND UNIVERSAL’S GRAD BASH 2015 of Pace High from Friday, May 1, 2015 to Saturday, May 2, 2015 at Universal Studios and Island Adventure located at 6000 Universal Blvd, Orlando, FL 32819.
I / We authorize on behalf of myself/ourselves my/our heirs, executors, successors, and assigns, in consideration of my/our child participating in UNIVERSAL STUDIOS PRE-PARTY AND UNIVERSAL’S GRAD BASH 2015 of Pace High School, release and agree to save and hold harmless the School Board of Santa Rosa County, Florida, their agents, servants, employees, and successors along with UNIVERSAL STUDIOS PRE-PARTY AND UNIVERSAL’S GRAD BASH 2015 Chairperson, any Committee Member and volunteers from any and all medical expenses of and to my/our child and/or our property resulting from such participation.











Date




Signature of Parent/Guardian of Student (if under 18)










Date




Signature of Student


THIS FORM MUST BE NOTARIZED

STATE OF FLORIDA

COUNTY OF _________________________
The foregoing instrument was acknowledged before me this _____day of _____________________, 20___, by (name of person acknowledging).
(NOTARY SEAL)


Personally Known




OR Produced Identification




Type of Identification Produced



I agree to arrive at UNIVERSAL STUDIOS PRE-PARTY AND UNIVERSAL’S GRAD BASH 2015 of Pace High School sober and alcohol and chemical substance free. I further agree to follow the laws of the STATE OF FLORIDA and guidelines of UNIVERSAL STUDIOS PRE-PARTY AND UNIVERSAL’S GRAD BASH 2015 and school rules of Pace High School.


___________________ ______________________________________________________________________

Date Signature of Student



***Students will be required to follow school Code of Conduct at all times.***











Name of Parent/Guardian




Phone

In case of emergency and the parent/guardian cannot be reached, name Emergency Contact below:











Emergency Contact / Relationship




Phone




Student’s Name:







Address:







Print










Home Phone:







Cell Phone:



















Insurance Company Name:







Policy #:




$50 Deposit & Permission Slip Deadline February 18 th. This will hold your spot and ensure our #s are correct for bus reservations. ***Make checks payable and mail to: Kirti Colvin 5667 Windrun Place Pace FL 32571



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