Editing previous response:

Please fix the highlighted areas below before submitting.

Valentine's Day Dance - All Grades

Please complete the form below. Required fields marked with an asterisk *

Prall Valentine's Day Dance

*Once the payment is made, it is non- refundable.

There is a 200 person max. The form will close when we have reached the max.

Date: 2/11/25

Time: 2:00 - 3:55

Need to know information: We will have a DJ, crafts, snacks and many more fun activities to keep the students engaged during the dance. Students are not permitted to change their clothes and must follow the school dress code. Pick up is the responsibility of the caregiver. There are no yellow buses at this time.

*Students are not permitted to leave the building and re-enter at dismisal. If they are attending the dance, they must report to the auditorium.

*Registration is due by 2/6/25 , NO EXCEPTIONS.

Last Name (Student) *

Answer Required

First (Student) *

Answer Required

Class*

Answer Required

(INITIAL HERE) This dance will include the following physical and sports activities. - Dancing. *

Initial Here

Answer Required

(INITIAL HERE) I understand that there are risks of injury associated with the above-listed physical and sports activities and I consent to my child’s participation in all these activities except for the following: *

INITIAL HERE

Answer Required

(WRITE N/A IF IT DOES NOT APPLY) Please indicate below any permanent or temporary medical or other condition, including special dietary and medication needs, or the need for visual or auditory aids, which should be known about your child: *

Answer Required

(INITIAL HERE) c) I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child. d) I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies. e) I agree and understand that I am responsible for the actions of my child. I release the school from all claims and liability that arise in connection with the trip, except if due to the negligence of school officials. f) I understand that I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member(s) during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site. g) I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, they will be subject to school disciplinary procedures and possible criminal prosecution. h) I understand that students who violate the school’s discipline code may be excluded in the future by the school from participating in a trip.*

Answer Required

In an emergency I can be reached at:*

Number Required

Additional Contact:*

Number Required

I give my permission for my child to participate in this activity. (SIGN BELOW)

Signature*

Signature Required

STUDENT DECLARATION

(to be signed by Middle School and High School students)

I have read this form and I understand that I am to act on this trip in the same responsible manner in which I am expected to conduct myself in school.

Students must write their name here to determine that they have read the rules and regulations. *

Answer Required

Dance Payment - Non Refundable *

Answer Required

$12.00

Confirmation Email

Confirmation Email *

Email Required