1. education
2. school

PARENTAL PERMISSION, RELEASE AND AGREEMENT FORM
We, the undersigned parents/guardians, give permission to allow our son/daughter
(circle one)
(name of graduate)
to participate in the post-graduation celebration (Project Graduation) planned by parents/Kamehameha Schools for the
evening/morning of May 24 - May 25, 2015.
In case an emergency procedure or treatment is required during Project Graduation, we give our consent to attending
Kamehameha Schools faculty members to take, arrange for or consent to the procedures for treatment at their discretion. In
consideration for allowing our graduate to participate in Project Graduation, we hereby release and further agree to indemnify
and hold harmless the parents supervising the event, the Kamehameha Schools, its Trustees, and employees from and against any
claims which we, or any other person, may have or claim to have, for any losses, damages or injuries arising out of our graduate's
participation, transportation to and from Project Graduation, or in the rendering of any emergency medical procedures to our
graduate for the duration of the event.
We understand that our graduate is to remain at Project Graduation from 10:00pm, May 24, 2015 to 9:00am, Monday, May 25,
2015 and we are responsible for his/her safe transportation home from the pick-up site at Kamehameha Schools Kapālama High
School, Konia pick-up area. We also understand that Project Graduation is intended to be alcohol- and drug-free and we will
cooperate fully to support the banning of alcohol and illegal drugs. We understand and agree that if our graduate is found to be
under the influence or in possession of alcohol or illegal drugs, we, or our designated O`ahu contact will be contacted to
immediately pick up our graduate to transport him/her home.
We understand there will be a non-refundable $25.00 registration fee to be paid during on-line Project Graduation registration.
Note: On-line registration will require a credit card or debit card payment. If you prefer to pay by check or money order, then
please have your senior remit check or money order payment to “Kamehameha Schools” at the `Akahi Student Center window
during the hours designated. Please write graduate’s name and PG 2015 in the memo field of the check. No cash will be
accepted.
**ALL PARENTS WHO HAVE LEGAL/JOINT CUSTODY MUST SIGN THIS FORM.
Parent/Guardian Name (Print)
Parent/Guardian Signature
Date
Parent/Guardian Name (Print)
Parent/Guardian Signature
Date
O`ahu Contact Person(s), Phone Number(s) & Medical Insurance Information
Please list below the person to contact during the event and phone number(s) where the person can be reached in case of emergency, etc.:
O`ahu Contact Name:
Name of Graduate's Physician:
Relationship to Graduate:
Phone Number:
Home Number:
Medical Insurance:
Group Number:
Cell Number:
Subscriber:
Policy Number:
Preferred Hospital:
Prescription Medication
If your child is on prescribed medication, which needs to be taken at any time for the duration of the event, please complete the following
information. During Project Graduation check in at Neal Blaisdell Center (NBC), please check in this medication with the nurse who will secure
and dispense medication as instructed on the medicine bottle or by parents/guardians.
Name of medication:
Dosage/Time:
Medication is for/Instructions:
STUDENT STATEMENT
In consideration of my being allowed to participate in the Kamehameha Schools Kapālama High School, Class of 2015 post-graduation
celebration, I agree to remain at the event from 10:00pm, May 24, 2015 until 9:00am, May 25, 2015. I agree to be dressed in the appropriate
attire during the event. I agree to support the ban of alcohol and illegal drugs during the event. I understand that if I am found to be under the
influence or in possession of alcohol or illegal drugs and/or behaving in an inappropriate manner at any time during the event, my parents or
designated O`ahu contact person will be immediately notified to pick me up and take me home. I understand that my parents/guardians will
provide for my safe transportation home following the conclusion of the event and I will not drive any vehicle from campus.
Student's Name (Print)
Student's Signature
Date
KAMEHAMEHA SCHOOLS KAPĀLAMA HIGH SCHOOL, CLASS OF 2015
GUIDELINES AND PARENTAL PERMISSION, RELEASE AND AGREEMENT FORM
TO PARTICIPATE IN POST-GRADUATION CELEBRATION (PROJECT GRADUATION)
Parents of the Kamehameha Schools Kapālama High School, Class of 2015, in partnership with the Kamehameha
Schools, have planned a post-graduation celebration (Project Graduation). The PARENTAL PERMISSION,
RELEASE AND AGREEMENT form (on reverse side) must be signed and submitted only after parents/guardians
and graduates understand and agree to the following guidelines:
Purpose of the Activity
To provide graduates with a final opportunity to be together with their classmates at a safe and alcohol- and drugfree celebration.
Description of the Activity
Following the graduation ceremony and visiting with family, graduates must check in for Project Graduation at the
registration tables located in the NBC Atrium area. They will be given a Project Graduation shirt and ID. Please
bring them a pair of jeans, casual pants or shorts, and comfortable shoes or slippers to change into and wear with
their Project Graduation shirt for the duration of the event. Please wait for them to change out of their graduation
attire, and take all of their excess graduation items home with you. Graduates may choose to take with them no
more than two fresh flower lei, a sweater or jacket, and a camera and/or cellular phone. Any other item(s) brought
to Project Graduation will be confiscated and returned the next morning at check out. Kamehameha Schools will
not be responsible for damage, loss or theft of any item that is brought to or confiscated prior to or during Project
Graduation. It is recommended that graduates do not wear jewelry.
After the graduates change and give all of their excess graduation items to their family, they are to return to
the Project Graduation check-in area then board the buses to be transported to the event venue.
Graduates will be provided with food, entertainment and activities throughout the night and return to school for a
snack and closing ceremony at Konia Field at 6:00am the following morning.
Parents will provide safe transportation following the closing ceremony and ensure that their son/daughter does not
drive a vehicle from the celebration. The graduate will be released only to an adult (preferably a
parent/guardian/sponsor). Pick-up is at 9:00 on the morning of May 25th at the Konia pick-up area at Kamehameha
Schools Kapālama High School. The adult, preferably a parent/guardian/sponsor, must come to the check-out tables
located on Konia Field with their graduate to sign him/her out. Check-out tables will be organized in alphabetical
order by graduates’ last names to expedite the check-out process.
Supervision
Kamehameha Schools Kapālama High School, Class of 2015 parent volunteers will provide the primary supervision.
Kamehameha Schools Kapālama High School administration and faculty members will also be in attendance and
assist with emergencies. There will be security personnel and a nurse on duty for the duration of the event.
Behavioral Expectations
Graduates are required to check in at the designated NBC area within one hour after the graduation ceremony has
concluded. Once checked in, they will not be allowed to leave the secured waiting area. Graduates are expected to
ride on their assigned bus. Buses will not leave until chaperones account for all graduates. After departing the
NBC, graduates must remain at the event venue until their release after the closing ceremony the following morning
at the Konia pick-up area at Kamehameha Schools Kapālama High School. All graduates will be transported to and
from the NBC, event venue and school only on Kamehameha Schools buses.
Alcohol and illegal drugs are strictly prohibited. The parents or designated O`ahu contact person of any
graduate found under the influence or in possession of alcohol or illegal drugs will be contacted and must
immediately pick up their graduate to transport him/her home.
Dress Code/Attire
Graduates are reminded that they are still representatives of Kamehameha Schools. Therefore, all attire should
follow typical school guidelines. For water activities, swim attire should be modest and appropriate. Girls swim
suits should fit properly. No Brazilian cut, thongs or skimpy swim suits allowed. If swim tops or bottoms are
deemed too skimpy by administration and/or parent chaperones, graduates may be asked to wear shorts or change
into more appropriate attire. Boys swim shorts should fit properly.