SALSTHON PERMISSION SLIP PAGE 1

 DATE Saturday, March 21 – Sunday, March 22 LOCATION SALSTHON will be held in the Birkenheuer Gym at Salesianum School. The entrance for the dance will be through the Fusco Fitness Center Plaza. START TIME Doors open to students at 10:00 PM. All students must be in the dance by 11:00 PM. END TIME The dance will conclude at 5:45 AM. An optional Sunday Mass will be offered at 5:45 AM and should conclude no later than 6:15 AM. EARLY DEPARTURE Students needing to leave the dance early will be permitted to leave at 12:30 AM if the consent form is signed below. A follow up call to a parent or guardian may be made to confirm the student’s departure prior to the event or that evening. Students wanting to leave at any other time must be picked up and escorted from the building by a parent or guardian and these arrangements must be made in advance on the permission slip below. No other students will be permitted to leave with another student or parent unless specifically noted below. You must make arrangements for a specific meeting time with your son or daughter as we are unable to make announcements for specific students during the dance. Please note that early departures create a strain on our staff and should only be arranged when absolutely necessary. SALSTHON GUESTS Each ticket purchased is good for one individual. Salesianum, Padua, Ursuline, and Archmere students are permitted to bring one ticketed guest. Guests must be a registered student at another high school. Middle school and college students are not permitted to attend. Guests attending SALSTHON must provide a permission slip guest form signed by a parent/guardian and by a member of the administration of their high school stating that the student is in good standing. All forms must be submitted by Wednesday, March 18. ID CARDS All students must have their current high school ID card in order to gain entry into the dance and must keep the ID on their person throughout the event. PROHIBITED ITEMS Salesianum is a drug, tobacco, and alcohol free campus. The use of any controlled substance or mind‐altering substance is not permitted and will not be tolerated. Students violating the drug/alcohol policy will have their parents called and will be asked to leave the dance. Salesianum students may also face further disciplinary consequences up to and including dismissal and guests will have the administration from their school notified. DRESS GUIDELINES The dress theme for the evening is red, white, and blue. Students are expected to be clean and neat in appearance, observing standards of modesty, moderation, and good taste. Modesty is admittedly a subjective interpretation, but one which we have a duty to uphold. Skirts are not permitted. Clothing that is too revealing, expose midriffs or cleavage, transparent, too short in length, or has sexually‐suggestive language are not appropriate. Students are responsible for communicating all dress code requirements to their invited guests. Any interpretation, judgment and final authority in these matters lies with the administrator in charge. SALSTHON PERMISSION SLIP PAGE 1 BAGS AND PERSONAL BELONGINGS Bags and other personal belongings (pillows, blankets, electronics, and large jackets) are not permitted in the dance. If staying at a friend’s house after the event we recommend students make arrangements for a bag transfer prior to the event. Small purses up to 6” are permitted, but are subject to search when entering. Please note that Salesianum does not provide secure storage and thus are not responsible for lost or stolen items. Please leave valuables and large amounts of cash at home. DANCING Dancing must comply with standards of modesty and safety. Inappropriate dancing includes, but is not limited to, slam dancing, moshing, freaking or booty dancing, or otherwise inappropriate or dangerous dancing. WHAT IS PROVIDED AT SALSTHON All food and beverages are provided to SALSTHON goers free of charge. MEDICATION If your son/daughter must take medication while at Salsthon, please fill out the attached medical information sheet. Please note that all medications must be given to and held by the nurse during the event. Students will turn in medication at check‐in. Medication should be in the original prescription container or for over the counter medication in store packaging and placed in a zip lock bag with your son/daughter’s name neatly printed on the outside. PERMISSION SLIP DUE DATE Permission slips and medication forms, if applicable, must be turned in by Wednesday, March 18. WHAT TO TURN IN 1.
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Attendee Permission Slip (page 3) Medical Information Sheet (page 4) HOW TO SUBMIT PERMISSION SLIPS Signed and completed permission slips can be submitted one of three ways: 1.
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SCAN AND SEND: Permission slips can be scanned and sent via email to the following address: [email protected] If possible, please rename the file before sending using the following format – LAST NAME, FIRST NAME – SCHOOL. (example: SMITH, JOE – SALESIANUM). OFFICE: Permission slips may be dropped off in the Student Union office at Salesianum MAIL: Send to the following address postmarked by March 18. Salsthon c/o Dan Jackman 1801 N Broom Street Wilmington, DE 19802 SALSTHON PERMISSION SLIP PAGE 2 ATTENDEE PERMISSION SLIP STUDENTS FROM: SALESIAMUM, PADUA, URSULINE STUDENT’S NAME: ______________________________________________________________________________ SCHOOL: __________________________________________________________________ GRADE: _____________ GUEST NAME: ________________________________________________ SCHOOL: _________________________ EMERGENCY CONTACT 1: NAME: _____________________________________________________ RELATIONSHIP: _____________________ PHONE: ________________________________________ EMAIL: ________________________________________ EMERGENCY CONTACT 2: NAME: _____________________________________________________ RELATIONSHIP: _____________________ PHONE: ________________________________________ EMAIL: ________________________________________ I give permission for my son/daughter to attend SALSTHON at Salesianum School on March 21 – 22 during the specified hours. My son/daughter understands that s(he) is responsible for their behavior and that of their registered guest (if applicable) while at the dance, and that school rules and expectations apply to extracurricular activities. I acknowledge that SALSTHON at Salesianum School, Inc. is a voluntary event and participants and their guardians agree to release Salesianum School, Inc. from any and all claims, injuries and causes of action arising from attendance at SALSTHON, whether or not caused by negligence or other fault of Salesianum School, Inc. and/or its employees. ________________________________________________________________ ____________________________ PARENT/GUARDIAN DATE PLEASE INITIAL ANY RELEVANT FIELDS BELOW: _______ I permit my child to leave SALSTHON at 12:30 AM on Sunday, March 22. I understand that I will be contacted prior to the dance to confirm and may be contacted the evening of to confirm departure. Please note that early departures create a strain on our staffing and should only be arranged when necessary. _______ I will be picking up my child before the official dismissal at ________ AM on Sunday, March 22. I understand that I must make arrangements for a meeting time and that I must enter the building through front entrance of the gym to escort my child out. In addition, I understand that I am not permitted to take any other children from the dance unless specific arrangements have been made prior to the event. SALSTHON PERMISSION SLIP PAGE 3 STUDENT MEDICAL INFORMATION This form will serve as a medical record while at Salsthon 2015. In the event of a medical emergency, it will supply the necessary information to be able to assist your son/daughter. Student’s Name: _______________________________________________________________________ Medical Insurance: ____________________________ Policy Number: ____________________________ Medical Conditions: ____________________________________________________________________ Food, medication or other allergies: _______________________________________________________ _____During my child’s participation in this event, I authorize the administration of minor first aid. If your child will be taking medication or over the counter medication while on at Salsthon, please send the medication in the original prescription container (your pharmacist will give you a duplicate container if needed) or in store packaging. Please place a copy of this form inside a zip locked bag along with the medication and print the name on the outside of the bag. The nurse on staff will assist with the prescription drug administration while over the counter medications will be self‐administered under supervision. Medication: ___________________________________________________________________________ Dose: __________________________________ Times to be taken: ______________________________ How should this medication be taken (any special instructions)? _________________________________ _____________________________________________________________________________________ Reason for prescription/medication: _______________________________________________________ Any side effects to be expected: __________________________________________________________ Number of pills/amount of medication in container: __________________________________________ _____ I give permission for a trained staff member to assist my child with prescription medication and for my child to self‐administer his over‐the‐counter medication under the supervision of the staff member. ____ In the event that I cannot be reached in an emergency medical situation, I give my permission to have my child transported to the nearest medical facility and for him to receive the necessary treatment by medical personnel. Parent Name (please print): ______________________________________________________________ Signature of parent: __________________________________________ Date: __________________ SALSTHON PERMISSION SLIP PAGE 4