2015 Senior Road Trip Permission Slip

Senior Road Trip 2015 will be Saturday, April 18, 2015 from 7:00 p.m. until 2:00 a.m. at Metea Valley High School.
This lock-in event and is hosted and chaperoned by senior parents and MVHS staff. All students attending are
required to have a parent/guardian signed permission slip on file, even if the student is 18 years old. Students will
NOT be permitted to leave once they have entered the party. THE MVHS code of conduct applies to this event.
Coats, purses, and other personal belongings must be left at home or in the students’ cars. Students should enter the
building through the athletic entrance located by the football stadium.
I hereby grant permission for my student ______________________________ to attend the Senior Road Trip
and participate in all activities offered, including all use of the equipment and/or attractions offered, including
without limitation, The Fun Ones Moon Jump, Inc., d/b/a The Fun Ones (“The Fun Ones”) (such activities are
hereinafter referred to as the “Activities”). I waive, release, and discharge any and all claims against The Fun Ones,
MVHS, the PTSA, and Indian Prairie District 204 (and their respective agents, employees, and volunteers), including
any claims regarding personal injury, death, or property damage that my student may sustain or which may result
from the student’s participation in the Activities. This release is intended to discharge in advance The Fun Ones,
MVHS, the PTSA, and their respective agents, employees, and volunteers, of any and all liability arising out of or
connected in any way with the participation of the student in the Activities). I understand that the Activities may
be hazardous and include physical or strenuous exercise; that serious accidents occasionally occur during the
Activities; and that participants in the Activities occasionally sustain mortal or personal injuries as a consequence
thereof. Knowing the risks involved, nevertheless I agree to assume all risks of injury for such student’s
participation in the Activities and to release and hold harmless The Fun Ones, MVHS, the PTSA, and Indian Prairie
District 204 for any liability for damages or harm caused by or as result of such student’s participation in the
Activities. I understand that this waiver, release and assumption of risk shall be binding on the heirs and assigns of
the undersigned and the student.
I understand that all students must be admitted to MVHS by 8:00 p.m. If my student is not in attendance by 8:00
p.m., I will be notified by phone.
Student Name (Please print) _________________________________________
Parent Name (please print) __________________________________________
Parent Signature ________________________________Date______________
Home Phone______________________________________________________
2nd Phone Number (Emergency Contact)__________________________________
Parent Email Address (important for communication about the event, please print neatly)
Ticket Fee Enclosed: Registration $65 (Fee will be $70 after February 15, 2015) Donations to offset event costs Total Enclosed (check made payable to MVHS PTSA) $_____________ $_____________ $ _____________
_______I DO NOT give my permission for my child’s name to be listed on the Senior Road Trip website
_______ I would like to volunteer to help with this event.
Please return this form and your payment to senior house to the attention of MVHS PTSA /SRT Registration, or mail to Catherine Ainger, 924 Whitewater Lane, Naperville, Illinois 60540. Questions regarding registration can be directed to Catherine Ainger, [email protected] The SRT
2015 Committee regrets that no refunds can be given after the SRT registration form has been received, as we have based our Games,
Entertainment and Foods contracts on our registered students, and contracts are now in place and deposits made.