1. education
2. school

2015 GRAD NITE ACTIVITY AT DISNEYLAND
PLEASE PRINT ALL INFORMATION
Name of St. Lucy's Student:
Guest’s Name & School:
Guest’s Home Phone:
DISNEYLAND
Destination:
Student Cell: (
Home Phone: (
)
)
Time of Departure:
Date:
)
5:00 P.M.
Saturday, May 16, 2015
Type of Transportation:
Amount:
Parent Cell: (
Bus
Time of Return:
*Approx. 3:00-4:00 A.M.
$110.00 PER PERSON - due with this form.
Parents/Guardians may not legally abdicate their full responsibility for their children to anyone, but they can give
permission for the school authorities to supervise an activity. This means that the Principal of the school appoints
instructors/chaperones to accompany and to supervise the activity, which your daughter/guest will attend. It is the
responsibility of the appointed instructor/chaperone, as a delegate of the school, to maintain reasonable and
responsible supervision at all times.
By signing your name you indicate to the authority of St. Lucy’s Priory High School that you understand the above and
permit your daughter/guest to attend the supervised activity. In addition, you acknowledge that your daughter/guest
will follow all the rules and regulations of St. Lucy’s Priory High School.
Gina Giuliucci, Principal
Mrs. Kelly Gonzalez, Moderator
1. In case of an emergency, I/we authorize a responsible representation of St. Lucy’s Priory High School to
accompany our daughter/guest to the nearest hospital for medical attention and to initiate any medical attention
necessary by authorized personnel. I understand that I will be notified as soon as possible.
2. Buses will leave at 5:00 p.m.
3. Buses will leave Disneyland approximately 60 minutes after the park closes at 2:00 a.m.
______________________________________________
STUDENT’S Parent/Guardian Signature
Date
______________________________________________
Student's Signature
Date
______________________________________________
GUEST’S Parent/Guardian Signature
Date
______________________________________________
Guest’s Signature
Date
Rev. March 2015
Disneyland® Parental Consent Form
Completed by St. Lucy’s Student and Guest
My daughter/guest (listed below) will be attending Grad Nite at the Disneyland® Resort. I
understand that certain rules and regulations will be in effect during Grad Nite, as listed below,
and I agree to advise my daughter/guest of such rules and regulations prior to Grad Nite. I also
acknowledge and agree that in the event my daughter/guest violates any of such rules or
regulations, my daughter/guest will be required to exit the Disneyland® Resort and in such event
I agree to be responsible for picking up my daughter/guest at the Disneyland® Resort.
Grad Nite Rules and Regulations:
The following items are prohibited (All students will be searched prior to entering the
Disneyland® Resort)
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•
•
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Alcoholic beverages or any illegal substance Glass containers Outside food or liquids Weapons of any kind, or objects that appear to be weapons Laser pointers or other items deemed potentially harmful or disruptive Smoking, vaping and electronic cigarettes I also expressly consent that my daughter/guest may be the subject of a pat down search by
Disney while on the premises of the Disneyland® Resort.
I hereby certify and represent that I have read the foregoing and fully understand the meaning and
effect thereof, and, intending to be legally bound I have signed this consent, on behalf of my
daughter/guest, on the date set forth below.
NAME OF DAUGHTER (print): ___________________________________________________
Student’s Signature: _________________________________________Date: _______________
Signature of Parent/Guardian: ______________________________________________________
NAME OF GUEST (print): _______________________________________________________
Guest’s Signature:_________________________________________Date: _________________
Signature of Parent/Guardian: ______________________________________________________
Rev. March 2015