Grad Night Online Registration Form (prev.)

Senior's Full Name:

Senior's Email (enter an email that you use often):

Senior's Phone #:

Senior's Birth Date:

Parent/Guardian-A Name:

Parent/Guardian-A Email:

Parent/Guardian-A Phone #:

Parent/Guardian-B Name: (optional)

Parent/Guardian-B Email: (optional)

Parent/Guardian-B Phone #: (optional)

Does the Senior have a life-threatening allergy or medical condition? NoYes - You will need to complete an Emergency Care Plan along with your Senior Release Form.

Any special notes or comments? (optional)