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LCI SAFE GRAD 2014 INFORMATION PACKAGE

ALL FORMS MUST BE COMPLETED, SIGNED AND RETURNED ALONG WITH
FULL PAYMENT (CHEQUE OR CASH), DURING THESE DATES/TIMES ONLY:
MONDAY, May 12
TH
, THURSDAY, May 15
TH
or FRIDAY, May 16
TH
6:00 p.m. 9:00 p.m.
Save-On Foods Community Room
1112 - 2
nd
A Avenue North
WHEN DROPPING OFF COMPLETED FORMS, PARTICIPANTS UNDER 18 MUST BE ACCOMPANIED BY AT
LEAST ONE PARENT/GAURDIAN WHO HAS SIGNED THE FORMS. PARTICIPANTS 18 OR OLDER CAN DROP
OFF COMPLETED FORMS WITH VALID IDENTIFICATION (i.e. DRIVERS LICENSE).
PERMISSION SLIP:
Permission Slips must be completed and returned.
PERSONAL INFORMATION:
PIPA (Personal Information Protection Act) is an act about privacy in the private section. It helps protect personal
information of the public. It creates common-sense rules about collection, using and disclosing personal
information.
PARENTAL GRADUATE/GUEST WAIVER FORM:
Both parent/guardian signatures are required.
Witness must be 18 years of age or older and independent of family.
Graduate/Guest must also sign and date waiver form.
WRISTBAND SALES:
Cost is $50.00/wristband.
Payment must accompany return of the completed information package.
NOTE: This is a non-refundable fee. No exceptions!
BEVERAGE SALES:
Beer and alcoholic coolers will be offered (Graduate/Guest choice)
Cost is $4.00/beverage to a maximum of 10 tickets.
Payment must accompany return of the completed information package.
NOTE: Beverage sales are refundable if the participant is unable to attend and the Committee Member indicated
below is notified by May 21st, 2014. No exceptions!
On May 24th, 2014 between 10:00 and 10:30 p.m., the graduate/guest will be given his/her wristband and beverage
tickets prior to loading the bus at the Soccer Center to the Safe Grad 2014 party.
Price List: 1 wristband ticket only = $50.00
1 wristband + 1 beverage = $54.00 1 wristband + 6 beverages = $74.00
1 wristband + 2 beverages = $58.00 1 wristband + 7 beverages = $78.00
1 wristband + 3 beverages = $62.00 1 wristband + 8 beverages = $82.00
1 wristband + 4 beverages = $66.00 1 wristband + 9 beverages = $86.00
1 wristband + 5 beverages = $70.00 1 wristband + 10 beverages = $90.00
IF ALL ENCLOSED FORMS ARE NOT RETURNED, ENTRY INTO SAFE GRAD WILL NOT BE GRANTED.
IF YOU ARE UNABLE TO DROP OFF THE COMPLETED FORMS ON May 12
th
OR May 15
TH
, or May 16
Th,
PLEASE
CONTACT THE SAFE GRAD 2014 COMMITTEE AT:
Email: lcisafegrad2014@gmail.com
COMPLETED FORMS WILL NOT BE ACCEPTED AFTER MAY 16
TH
WITHOUT PRIOR NOTIFICATION!
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LCI SAFE GRAD 2014 PARENT/GUARDIAN VOLUNTEER FORM
LCI Parents/Guardians,
We are in need of volunteers to help make Safe Grad 2014 a successful one. We have a good group of parents already
but are looking for your help as well! We are asking parents to get involved with your son/daughters Safe Grad evening.
Please include your name and contact information below and return with the information package.
Thank you!
Parent/Guardian Volunteer Name(s): ______________________________________________
Parent/Guardian Volunteer Phone No.: _______________________________________ (Home)
_________________________________________ (Cell)
Parent/Guardian E-mail Address: ______________________________________________
We are currently looking for volunteers for the following areas:
_____ Decorating at the venue (Friday, May 23 between 8 am and 4 pm)
_____ On-site set-up (Saturday, May 24 between 12 noon and 5 pm)
_____ Security at event (walking venue, manning doorways) (Saturday, May 24 between 10 pm and 5 am)
_____ Assistance with Food Service (Saturday, May 24 between 10 pm and 2 am)
_____ Assistance with Liquor Service (Saturday, May 24 between 10 pm and 5 am)
_____ Clean up and take-down (Sunday, May 25 from 5 am 7 am)
_____ Van Drivers to escort students home, if needed (Saturday, May 24 from 10 am 5 am)
_____ Other help as needed: I am available to help at the following time: ____________________________________
We cannot make this possible unless we have the parent support and help, so please
volunteer.it is a fun evening for us parents as well!
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LCI SAFE GRAD 2014 PERMISSION SLIP
GRADUATE INFORMATION
PLEASE PRINT
NAME: _________________________________________________________________
PHONE NO.: (Home) _________________________ (Alternate) _________________________
BIRTHDATE: (DD/MM/YY) __________/__________/__________
MEDICAL CONDITIONS/ALLERGIES: ______________________________________________
____________________________________________________________________________
This year, parents/guardians are requested to be available during the entire night at home and by phone to come
and pick up your son/daughter, if applicable. When a graduate wishes to leave, they will tell the Safe Grad 2014
Committee who will, in turn, contact the pick up contact at the number(s) below, for pick up.
IF the situation arises that a graduate violates any of the Safe Grad rules (outlined herein), they will be driven
home to the address provided where the listed responsible adult must sign for them.
PICK UP CONTACT NAME: ____________________________________________________
PICK UP CONTACT PHONE NUMBER: _____________________________________________
DROP-OFF ADDRESS (NOTE: This is the address which your son/daughter will be taken to during or after Safe
Grad, if necessary. A responsible adult MUST be at this address during the entire night of the LCI Safe Grad
2014):
DROP-OFF NAME: ____________________________________________________
DROP-OFF ADDRESS: ____________________________________________________
DROP-OFF PHONE NO.: ____________________________________________________
FEES: Wristband 1 Wristband @ $50 = $50.00
Beer _____ beer @ $4 each = __________
Coolers _____ coolers @ $4 each = __________
(Maximum of 10 drink tickets per graduate)
TOTAL DUE: ____________________
TOTAL PAID: ____________________ (Cash _____ or Cheque _____)
** PLEASE MAKE CHEQUES PAYABLE TO LCI SAFE GRAD**
_________________________________________________________________________________________________
YOUR GUESTS NAME: ____________________________________________________________________________
(if applicable) (First Name) (Last Name)
If your Guest is attending, he/she must fill out and return the LCI Safe Grad 2014 Guest Information Permission
Slip (included in this package).
Graduate Parents/Guardians Initial(s): __________ __________
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LCI SAFE GRAD 2014 PERMISSION SLIP
GUEST INFORMATION
PLEASE PRINT
NAME: _________________________________________________________________
PHONE NO.: (Home) _________________________ (Alternate) _________________________
BIRTHDATE: (DD/MM/YY) __________/__________/__________
MEDICAL CONDITIONS/ALLERGIES: ______________________________________________
______________________________________________________________________________
This year, parents/guardians are requested to be available during the entire night at home and by phone to come
and pick up your son/daughter. When a guest wishes to leave, they will tell the Safe Grad 2014 Committee who
will, in turn, contact the pick up contact at the number(s) below, for pick up.
IF the situation arises that a guest violates any of the Safe Grad rules (outlined herein), they will be driven home
to the address provided where the listed responsible adult must sign for them.
PICK UP CONTACT NAME: ____________________________________________________
PICK UP CONTACT PHONE NUMBER: _____________________________________________
DROP-OFF ADDRESS (NOTE: This is the address which your son/daughter will be taken to during or after Safe
Grad, if necessary. A responsible adult MUST be at this address during the entire night of the LCI Safe Grad
2014):
DROP-OFF NAME: ____________________________________________________
DROP-OFF ADDRESS: ____________________________________________________
DROP-OFF PHONE NO.: ____________________________________________________
FEES: Wristband 1 Wristband @ $50 = $50.00
Beer _____ beer @ $4 each = __________
Coolers _____ coolers @ $4 each = __________
(Maximum of 10 drink tickets per graduate)
TOTAL DUE: ____________________
TOTAL PAID: ____________________ (Cash _____ or Cheque _____)
** PLEASE MAKE CHEQUES PAYABLE TO LCI SAFE GRAD**
_________________________________________________________________________________________________
YOUR GRADUATES NAME: _________________________________________________________________
(First Name) (Last Name)
Your Graduate must include this form upon returning the package to the LCI Safe Grad 2014 Committee.
Guest Parents/Guardians Initial(s): __________ __________
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LCI SAFE GRAD 2014
RULES FOR THE SAFE GRAD PARTY
The RULES are put in place with the intention of providing the students with a safe and fun environment for all attending.
Prior to boarding the bus on May 24
TH
, please read the RULES and understand the consequences if RULES are broken.
NO ALCOHOL at the Soccer Center, or on the bus or on your person.
DO NOT REMOVE YOUR WRISTBAND. If anyone is found not wearing their wristband, it will be assumed that
they do not belong at the party and will be immediately removed from the party site and returned home.
NO DRUGS. If any drugs are found, the person(s) involved will be immediately removed from the site and taken
to the address on their wristband(s).
NO FIGHTING. If anyone is found fighting or found instigating a fight, they will be immediately removed and
taken to the address on their wristband.
DO NOT LIE DOWN FOR ANY REASON. If anyone is found in a prone position (lying flat on the ground), they
will be immediately removed from the site and taken to the address on their wristband.
NO CELLULAR PHONES ALLOWED. If anyone is found carrying or using a cellular phone they will be
immediately removed from the site and taken to the address on their wristband.
DO NOT LEAVE THE PERIMETER OF THE PARTY. If anyone is found leaving or entering the party site without
proper authorization, they will be immediately removed from the site and taken to the address on their wristband.
NO BACKPACKS, HANDBAGS, OR PURSES. You will not be permitted to board the bus if you are carrying any
type of tote bag or pack. Girls may have a clutch big enough to carry a lip gloss and/or feminine products, but ALL
CLUTCHES WILL BE INSPECTED.
LOST OR STOLEN PERSONAL ITEMS. The Safe Grad 2013 Committee will not be responsible for any jewelry
or personal items that are lost in transit, to or from the party or at the party site.
IF YOU ARE FOUND TO BE OUT OF CONTROL (i.e. openly vomiting, incoherent, passing out, etc.), you will
be immediately removed from the site and taken to the address on their wristband.
DRESS APPROPRIATELY. Dress in layers.
DO HAVE A SAFE AND FUN GRADUATION PARTY
LCI Safe Grad Rules Committee
THIS PAGE MUST BE INITIALED BELOW AS INDICATED:
Graduate Initial: __________ Parents/Guardians Initial(s): __________ __________
Guest Initial: __________ Parents/Guardians Initial(s): __________ __________
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LCI SAFE GRAD 2014
DISCLOSURE
1. LCI Safe Grad 2014 (Safe Grad) is a graduation party for graduates of the Lethbridge Collegiate Institute and their
guests.
2. LCI and Lethbridge Collegiate Institute are phrases used by the LCI Safe Grad Committee. Note, however, that
LCI Safe Grad 2014 and all activities and events related to LCI Safe Grad 2014 are NOT activities and events
authorized, sanctioned, or condoned by Lethbridge School District No. 51, its trustees, employees, volunteers or
agents. Therefore, Lethbridge School District No. 51 does not extend any insurance coverage or responsibility for
any activity or event organized by the LCI Safe Grad 2014 Committee including, but not limited to, any event
involving minors and alcohol.
3. Safe Grad will be held on Saturday, May 24, 2014 in the Lethbridge area. Its location is undisclosed for security
reasons. It will begin on May 24, 2014 following Grad Grand March, and Dance, and concludes in the early hours of
May 25, 2014.
4. Graduates and guests will be transported to Safe Grad (by bus). Parents/guardians are asked to pick up their
graduate and/or guest when contacted by telephone from the Safe Grad Committee. If a graduate and/or guest
breaks any rule as listed, they will be transported back (by volunteer parent drivers) to the address on the wristband
that will be provided by each graduate and guest.
5. Safe Grad is a graduation party where students and guests will be consuming alcoholic beverages. The goal of Safe
Grad is to allow them to do so safely, and particularly without access to automobiles. Food and music is provided.
Beer and alcoholic coolers are available with prior beverage ticket purchases.
6. Guests must be at least 16 years of age and not older than 21 years of age.
7. The parents or guardian of graduates and guests, by signing the attached personal consent and waiver form,
acknowledge that they are members of the LCI Safe Grad 2014 Committee.
8. Each graduate and guest, by signing the attached acknowledgement, agrees to abide by the directions of the
volunteers at Safe Grad, to abide by the rules of Safe Grad, and acknowledges that he or she is a member of the
LCI Safe Grad 2014 Committee.
9. Each graduate and guest will be issued a wristband, identifying the name of the graduate or guest, and setting out
the address to which he or she will be delivered, if necessary. The contact phone number provided will be used to
contact the pick up contact to pick up the graduate and/or guest.
10. RULES: In addition to the Rules for the Safe Grad Party contained in this package and which you have initialed
your consent, the following rules also apply:
Any graduate or guest who, in the opinion of the volunteers at Safe Grad, is excessively intoxicated, or
who is engaging in obstructive or dangerous behavior, or who disregards the instructions of supervision,
or who removes or loses his or her wristband, or who leaves Safe Grad for any reason will be immediately
taken home.
Graduates and guests are subject to purse, clutch and wallet searches for prohibited items, including
sharp objects, weapons, non-prescription drugs, alcohol and cell phones. Note: backpacks are not
permitted.
A responsible adult must be at the address given on the graduates and guests wristband throughout the
entire night of Safe Grad.
THIS PAGE MUST BE INITIALED BELOW AS INDICATED:
Graduate Initial: __________ Parents/Guardians Initial(s): __________ __________
Guest Initial: __________ Parents/Guardians Initial(s): __________ __________
Parents/Guardians: Please note that you will receive a call from a Safe Grad Committee parent to pick up your
son/daughter, when your son/daughter is ready to leave the event.
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PARENTAL/GRADUATE/GUEST WAIVER FORM
WARNING: BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT
TO SUE. PLEASE READ THIS DOCUMENT AND ATTACHED DISCLOSURE CAREFULLY.
1. My child wishes to participate in LCI Safe Grad 2014. I have read and I understand the contents of the
disclosure, attached hereto, which sets out details of the LCI Safe Grad 2014 and I consent to and give my
permission for my child to participate in the program.
2. I hereby acknowledge and agree that LCI Safe Grad 2014 involves elements of risk and that death, injuries, loss
and damage can occur to students while participating in these activities.
3. I further acknowledge and agree that death, injury, loss or damage can occur without any fault of either the
student, or the LCI Safe Grad 2014 Committee. I hereby freely accept and assume all risks associated with the
participation in the LCI Safe Grad 2014. In consideration for my childs voluntary participation in LCI Safe Grad
2014, I hereby waive any and all claims, expenses, demands, costs, suits, liabilities and causes of action against
each member of the LCI Safe Grad 2014 Committee which may arise out of such injury or loss or damage and I
release each member of the LCI Safe Grad 2014 Committee from any liability in that regard.
4. I accept and agree that it is my childs responsibility to abide by all the laws and obey all rules set out for LCI Safe
Grad 2014. I agree that the supervisors of LCI Safe Grad 2014 may require my child to return home if a breach of
those rules occurs.
5. In consideration for my childs voluntary participation in the LCI Safe Grad 2014, I further agree to indemnify and
save harmless each member of the LCI Safe Grad 2014 Committee from any and all expenses, costs (including
legal costs) or financial obligations arising from any suits, demands, claims, actions of any kind which may
become liable by reason of any injury, loss, damage or death resulting from, or occasioned to or suffered by any
person or any property as a result of any act, neglect or default of myself or child.
6. I acknowledge that it is my responsibility to advise the LCI Safe Grad 2014 Committee of any medical and/or
health concerns, which may affect my childs participation in the LCI Safe Grad 2014.
7. I acknowledge and agree that any supervisor appointed by the LCI Safe Grad 2014 Committee may take any
actions deemed necessary by the supervisor for my childs health, safety and well-being, including the securing of
medical treatment and transporting my child home (at my expense).
8. I hereby acknowledge that I have read and understand the foregoing, including the attached Disclosure, and do
hereby approve and consent to all the above. I hereby give permission for my child to participate in the LCI Safe
Grad 2014.
SIGNED at Lethbridge, Alberta the __________________day of ____________________ 2014.
________________________________ ____________________________________
Parents Name and Signature Witness
________________________________ _____________________________________
Parents Name and Signature Witness
NOTE: ALL PARENTS AND GUARDIANS OF THE MINOR GRADUATE OR GUEST MUST SIGN ABOVE.
I have read the above and it has been explained to me by my parent or guardian. I agree to abide by the rules in the
Disclosure and by any instructions of the supervisors of the LCI Safe Grad 2014 Committee.
______________________________________ ______________________________________
Signature of Graduate Signature of Guest
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PERSONAL INFORMATION AGREEMENT
PIPA (Personal Information Protection Act) is an act about privacy in private sector. It helps protect personal information
of the public. It creates common-sense rules about collecting, using, and disclosing personal information.
1. What personal information does LCI Safe Grad Committees collect?
- We will be collecting names, addresses, phone numbers and birth dates.
2. Why do we collect personal information?
- We collect this information so we know who will be attending the function.
- Name, address for the purpose of driving the participant home, phone for the purpose of confirmation,
birthdates for the purpose of the age limit which is in place for attending (16 21 years).
3. How do we collect this information?
- By permission forms which must be filled out and signed by parent/guardian if under 18 years of age.
4. What do we use it for?
- We use this information in order to make wristbands. The wristband will contain this information, which
must be worn at all times during the event by participants. The purpose of the wristband is to ensure
attendance and to provide transportation home after the event.
5. Where do we keep this information?
- The Rules Committee Chairperson will keep this information.
6. Who has access to or uses it?
- This information is given to other committees as needed.
7. When is it disposed of?
- All information is shredded after the function is over and everyone is transported home.
Do you agree to supply this information for LCI Safe Grad Purposes? YES NO
If you agree to this, a signature is required at the bottom. If the person is under the age of 18, parent/guardian
consent must be given.
________________________________ ___________________________________
Signature(s) (Both parents, if possible) Witness
________________________________ ___________________________________
Signature(s) (Both parents, if possible) Witness
________________________________
Date
A SIGNED AGREEMENT MUST BE RETURNED IN ORDER TO ATTEND!