PARENT CONSENT & AUTHORIZATION FORM
PROJECT GRADUATION CELEBRATION
June 6, 11:30 PM thru June 7, 7:00 AM
At Katy Times Square – 402 West Grand Parkway South, Katy, Texas 77450
Students will be transported from Kempner High School to Katy Times Square via FBISD buses
PARENTS ARE STRONGLY URGED TO DROP OFF AND PICK UP THEIR STUDENTS FROM KEMPNER HIGH SCHOOL.
Please fill in all blanks.
Student Name___________________________________________________________________
Student Address___________________________________ Student Date of Birth__________________________
Parent/Legal Guardian Name____________________________________________________________________
Parent/Legal Guardian Home Phone___________________________ Cell Phone______________________
Parent/Legal Guardian email_________________________________________________
Emergency Contact Name ______________________________________
Emergency contact Phone Number_________________________________________________
Emergency contact Relationship to Student___________________________________
Student Insurance Company______________________________________________
Student Insurance ID Number_____________________________________________
Student Doctor and Phone Number _______________________________________________________________
By signing this document below, I give my permission for my student, _________________________________
to attend the Pro Grad Lock in Party listed above.____________________ parent/legal guardian initials
I give my permission for my student to travel to and from Katy Time Square, 402 West Grand Parkway South,
Katy, Texas 77450 via FBISD buses.___________________________ parent/legal guardian initials
I also understand that my student will not be able to leave the party before 7:00 am unless I or the emergency
contact person comes to Katy Times Square (402 West Grand Parkway South, Katy, Texas 77450) to sign them
out.___________________ parent/legal guardian initials
I further give Project Graduation's executive board officers permission to seek and approve emergency medical
treatment for my student. ______________________ parent/legal guardian initials
I have received and read the attached rules and information sheet for the KHS Project Graduation event.
__________________ parent/legal guardian initials
Parent/Legal Guardian Name Printed_____________________________________________________________
Parent/Legal Guardian Signature_________________________________________________________________
Date______________________
I am willing to be a chaperone the night of Project Graduation. Yes _______ No_________
KHS PROJECT GRADUATION
Katy Times Square – 402 West Grand Parkway South, Katy, Texas 77450
SATURDAY, JUNE 6, 11:30PM TO SUNDAY, JUNE 7, 7:00 AM
RULES AND INFORMATION
We are excited to have this celebration of your graduation from Kempner High School. There are a few
rules that will be followed by all graduates attending the all night, drug free and alcohol free party.
1. Only members of the Kempner High School 2015 graduating class may attend this event. All seniors wishing
to attend this celebration must purchase a ticket and return the signed consent and authorization form
prior to attending the party. Forms will be available at all lunches for pick-up and turn in from May 12,
2015 thru May 21, 2015 and for printing through email.
TICKETS ARE $25! Cash or Checks made
payable to Kempner Pro Grad 2015. No Refunds will be given. Thursday, May 21, 2015 is the last day to
purchase tickets.
2. Graduates must bring valid ID to sign in. Graduates will sign in from 11:15 pm to 11:45 pm and will be
directed onto FBISD buses. Buses will leave Kempner High School promptly at 11:50 pm. Students may not
be dropped off at Katy Times Square. If students miss the bus they will not be allowed to attend the Pro
Grad event. Parents are strongly urged to drop off and pick-up their graduates from Kempner High
School. Graduates will have been up all night having a blast and the Pro Grad committee wants to
ensure they arrive home safely.
3. No outside food or drinks will be allowed into the party.
4. At the discretion of the FBISD security, a graduate will be denied admittance if they are under the
influence of, or in possession of any alcohol, controlled substances or weapons.
5. All bags and purses are subject to search by FBISD security. Please leave all valuables at home. Pro
Grad is not responsible for lost, damages or stolen items.
6. No graduate will be allowed to leave Katy Times Square prior to 7:00 am without a parent, legal guardian or
emergency contact personally picking them up from Katy Times Square. Parents, legal guardians or
emergency contacts must be listed on the consent form and show valid identification before a student will
be released early from the event.
Again, parents are strongly urged to drop off (Saturday, June 6, 2015 11:15 pm – 11:45 pm) and
pick-up (Sunday, June 7, 2015, 7:00 am) their graduates from Kempner High School.
If you are a parent/legal guardian and wish to chaperone the night of Project Graduation please email us at
[email protected] or call Stacy Villarreal at 713-302-0926