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Garfield Senior Class of 2019 - Grad Night Party “Go Dog Go!” Garfield seniors have one, final opportunity to celebrate together at the Grad Night party, an all- night, safe, and fun event that all graduating students are welcome and encouraged to attend. What is Grad Night? Following the Commencement ceremony next June 2019, students will go by bus with their chaperones to “mystery” party venues for all-night entertainment, food, and fun. The buses will return them to Garfield at 6 AM the next morning. The Garfield Community PTSA provides major funding for this last “evening of enchantment” for the class of 2019. The ticket cost includes: charter bus rides, food, entertainment, and a senior gift. We want as many seniors as possible to attend the party, so we are accepting ticket orders NOW! Read on for how to purchase tickets for your Senior student: https://garfieldptsa.ejoinme.org/gradtix Parents are needed as chaperones, so please contact the Grad Night team if you would like to help! Los que terminan la escuela Garfield tiene una última oportunidad para celebrar juntos en la fies- ta de La Noche de Los Graduados. Es un evento seguro y divertido de toda la noche para todos los que se gradúan en el 2019. Que es La Noche de Los Graduados? Después de la ceremonia de graduación el próximo Junio, los estudiantes van en autobús acompañados por chaperónes (padres de familia) a dos lugares festivos de “misterio" para una noche entera de entretenimiento, comida y diversión. La Asociación de Padres y Profesores (PTSA) paga la mayor parte de esta “noche encantadora” para la Clase de Graduados del 2019. El costo del boleto incluye bus privado, comida, diversiones y un regalo para el estudiante. ¡Queremos que la mayoría asista a la fiesta, entonces ya se está aceptando las reservaciones AHORA! Por favor lean como comprar los boletos para el estudiante de la clase del 2019: https://garfieldptsa.ejoinme.org/gradtix Necesitamos padres de familia como chaperónes. ¡Por favor comunicarse con el comité organizador se desea ayudar! Gracias! 嘉菲高中的畢業班同學將會有一次最後一同慶祝的機會畢業班同學同樂晚會一個整晚、 安全,而又充滿歡樂的活動,歡迎並鼓勵所有畢業班同學出席參加。 畢業班同學同樂晚會是甚麼? 2019年 月的畢業典禮結束後,畢業班的同學會和他們當晚的同伴乘巴士到兩個同樂晚 會 的會場,晚會將整晚舉行 ,並安排有娛樂節目和食物供應,當然還有很多很多的歡樂。 巴士會在第二天的上午六時返回嘉菲高中校舍。嘉菲高中的家長會支付這個專為2019畢業班同學舉辦的最後一次『魅力之夜』活動的主要開支。門票費用包括:巴士租賃、 食 物、娛樂節目及畢業生禮物。希望所有的畢業班的同學都能參加,我們現在已開始發 門票!請留意如何為你的畢業班的同學購買門票 https://garfieldptsa.ejoinme.org/gradtix 我 們需要家長擔任當晚的同 伴,若有興 趣,請聯絡同樂晚會的籌委成員。

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Page 1: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda

Garfield Senior Class of 2019 - Grad Night Party “Go Dog Go!”

Garfield seniors have one, final opportunity to celebrate together at the Grad Night party, an all-

night, safe, and fun event that all graduating students are welcome and encouraged to attend.

What is Grad Night? Following the Commencement ceremony next June 2019, students will go

by bus with their chaperones to “mystery” party venues for all-night entertainment, food, and fun.

The buses will return them to Garfield at 6 AM the next morning. The Garfield Community PTSA

provides major funding for this last “evening of enchantment” for the class of 2019. The ticket cost

includes: charter bus rides, food, entertainment, and a senior gift. We want as many seniors as possible

to attend the party, so we are accepting ticket orders NOW! Read on for how to purchase tickets for

your Senior student: https://garfieldptsa.ejoinme.org/gradtix

Parents are needed as chaperones, so please contact the Grad Night team if you would like to help!

Los que terminan la escuela Garfield tiene una última oportunidad para celebrar juntos en la fies-

ta de La Noche de Los Graduados. Es un evento seguro y divertido de toda la noche para todos los que

se gradúan en el 2019.

Que es La Noche de Los Graduados? Después de la ceremonia de graduación el próximo Junio,

los estudiantes van en autobús acompañados por chaperónes (padres de familia) a dos lugares festivos de

“misterio" para una noche entera de entretenimiento, comida y diversión. La Asociación de Padres y

Profesores (PTSA) paga la mayor parte de esta “noche encantadora” para la Clase de Graduados del

2019. El costo del boleto incluye bus privado, comida, diversiones y un regalo para el estudiante.

¡Queremos que la mayoría asista a la fiesta, entonces ya se está aceptando las reservaciones AHORA!

Por favor lean como comprar los boletos para el estudiante de la clase del 2019:

https://garfieldptsa.ejoinme.org/gradtix Necesitamos padres de familia como chaperónes. ¡Por favor

comunicarse con el comité organizador se desea ayudar! Gracias!

嘉菲高中的畢業班同學將會有一次最後一同慶祝的機會─畢業班同學同樂晚會─一個整晚、

安全,而又充滿歡樂的活動,歡迎並鼓勵所有畢業班同學出席參加。

畢業班同學同樂晚會是甚麼?

2019年 月的畢業典禮結束後,畢業班的同學會和他們當晚的同伴乘巴士到兩個同樂晚 會 的會場,晚會將整晚舉行

,並安排有娛樂節目和食物供應,當然還有很多很多的歡樂。

巴士會在第二天的上午六時返回嘉菲高中校舍。嘉菲高中的家長會支付這個專為2019年

畢業班同學舉辦的最後一次『魅力之夜』活動的主要開支。門票費用包括:巴士租賃、

食 物、娛樂節目及畢業生禮物。希望所有的畢業班的同學都能參加,我們現在已開始發

售門票!請留意如何為你的畢業班的同學購買門票 https://garfieldptsa.ejoinme.org/gradtix 我 們需要家長擔任當晚的同

伴,若有興 趣,請聯絡同樂晚會的籌委成員。

Page 2: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda

Garfield Senior Class of 2019 - Grad Night Party “Go Dog Go!”

Ardada ku jirta galaaaska ugu dambeeya ee Dugiga sare Gaarfiil,waxay ugu dambeyn ka faaiidaysan

karaan, inay u dabaaldegaan caweys habeen dhan ah oo,nabadgelyada la sugayo.Waxaa lugu soo dhaweynayaa

dhamaan ardayda qalin jebineysa oo dhan, waxaana la dhiiri gelinayaa in ay yimaadaan.

Muxu yahay habeenka?

Waa habeen dabaaldeg loo sameynaayo sannadka soo socda ee Juun, 2019ka ardada qalinjebineysa oo

dhan. Ardadu waxay raacayaan basas (Buses), waxaana raacaya ardada dad masuul ah oo ay ka midyihiin walaali-

in. Waxay tegayaan laba meelood oo kala duwan oo aan cid loo sheegin nabad gelyo awgeed (two mystery).

Caweyskaas wxuu soconayaa habeenkaas oo dhan,madadaalo iyo cunno ayuu ahaanayaa. Aradada Basas ayaa ku

celinayaa subaxda dambe Iskuulkoodii saacadu marka ay tahay 6am. Gudiga walidiinta iyo macalimiinta ka

kooban oo loo yaqaan (PTSA) ayaa soo qabanqaabinyey, oo kharajka intiisa badan bixiyey habeenkaas xaflada

2019ka.

Hadaba, waxaan rabnaa sida suurtagalsan oo aan oo ardo badan ay caweyskaa uga soo qaybgalaan.

waxaan kale oo aan sheegaynaa waalidiinta ardayda in ay hadda ay dalbankaraan tigidhada(Ticket). Tigidkaas

waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda qalinjebiya. Waalidiinta waxaan loo sheegayaa in

ay raaci karaan caruurtooda habeenkaas,fadlan la soo xariira (Grad Night team) haddi aad rabtaan inaad ardada

wax ka caawisaan. https://garfieldptsa.ejoinme.org/gradtix

የ ጋርፊልድ 2019 ተመራቂዎች ክፍል የ ምረቃ

ምሽት - ጎ ዶግ ጎ

የ ምረቃ ምሽት ፓርቲ የ ጋርፊልድ ተመራቂዎች አንድ ላይ ሆነ ው ምረቃችውን ሇማክበርና ሇመደሰት የ መጨረሻ አንድ

እድላቸው ነ ው፧ ፧ ይህ ፓርቲ ተመራቂዎቹ ያሇምንም ችግር አንድ ላይ ሆነ ው የሚዝናኑበት ሲሆን እያንዳንዱ ተማሪ

እንዲሳተፍ በማበረታታት እንጋብዛሇን፧ ፧

የምረቃ ምሽት ምንድነው?

የ 2019 የ ጁን የ ቀኑን ምርቃ በመከተል ተማሪዎች በአውቶቢስ ከአጃቢዎች ጋር በመሆን ወደተዘጋጀላቸው ሁሇት ሚስጥራዊ ፓርቲ ሇሙዚቃ

ምግብና ዳንስ ይሄዳለ፧ ፧ አውቶቢሱም በማግስቱ ጠዋት በ6፧ 00 ኤም ጋርፊልድ ይመልሳቸዋል፧ ፧ የ ወላጆችና

ተማሪዎች ማህበር ፒቲኤ ብዙውን ወጪ የሚሸፍን ሲሆን ከቲኬቶች ሽያጭ የሚገ ኘው ገ ቢ ደግሞ ሇአውቶቢስ ኪራይ ሇምግብና ሇምሩቃኑ ስጦታ

መግዣ ይውላል፧ ፧ ምሩቃንም በብዛት አንዲሳተፉ እንፈልጋሇን፧ ፧ ከአሁኑ ቲኬት መግዛት ሇሚፈልጉ ተመራቂዎች ትእዛዝ እንቀበላሇን፧ ፧

ቲኬት መግዛት እንዴት እንደምትችለ ከታች ያንብቡ፧ ፧ አጃቢ የ ሚሆኑ https://garfieldptsa.ejoinme.org/gradtix ላጆች ስሇምንፈልግ አጃቢ መሆን

ከፈሇጉ እባሇክዎምረቃው ምሽት ኮሚቴ

ይደውለ፧ ፧

Page 3: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda

GHS Seniors: Order Grad Night Tickets Today! The Garfield Community PTSA is committed to making sure that every Senior who wants to

attend Grad Night can attend, so we offer ticket prices on a sliding scale, as well as

scholarships. The actual per-student cost for Grad Night is $165, which includes the charter

bus, food, entertainment, and senior gift. The PTSA has traditionally underwritten this event,

but we are asking families to pay at the level that works best for them, including sponsoring a

scholarship, if possible. All donations are welcome!

Student Name: Student mobile #

Parent/Guardian Name:

Address:

City: State: ZIP:

Parent/guardian phone: Email: _ @_

A. TICKET OPTIONS - choose one:

$165 (actual Grad Night per-student price) $50 (discounted price) $25 (free/reduced lunch student price)

Please contact me about a scholarship

I will pay $ (between $50-160)

B. SCHOLARSHIP DONATIONS - I would like to make an additional Grad Night donation:

ticket(s) @ $165 each. TOTAL: $

$500 $250 $100 $50 $25 Other: $

TOTAL of A & B:

C. PAYMENT OPTIONS - choose one:

My check (payable to GHS PTSA-Grad Night) for $ is enclosed. (Be sure to write

your student’s first and last name in the “memo” line.)

I will purchase my ticket online by clicking on this link to the Garfield PTSA website:

https://garfieldptsa.ejoinme.org/gradtix

Please return: 1) this completed form, 2) the Party Agreement form, 3) the Allergy/Emergency form,

and your check to the Garfield main office, or send to: Garfield PTSA – Grad Night, PO Box 22748,

Seattle, WA 98122-0748.

Page 4: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda
Page 5: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda

The signature page (next page) must be attached or printed on the back side of this form.

All information contained herein is strictly confidential, protected by copyright and intended for use only by the 2019 committee. Use of this form, or any part or derivation by any committee, group or individual not currently working with Grad Nights is strictly prohibited.

© 1983-2016 Grad Nights. Grad Nights® is a registered trademark of The Howard Group, Inc.

Senior Name: Date of Birth:

Senior Cell Phone: Senior Email:

Address:

Parent/Guardian Name(s):

Parent/Guardian Phone(s):

Parent/Guardian Email:

Emergency Contact Name:

Relationship to Student: Phone Number(s)

Medications:

Chronic Illnesses/Allergies: Date of Last Tetanus Shot:

Insurance Provider:

Does your senior have a life-threatening food allergy? □ NO □ YES – You will also need to complete, at a later date, an

Emergency Care Plan (“ECP”). The Parent Planning

Committee will have ECPs available.

2019 SENIOR CLASS GRADUATION PARTY AGREEMENT

RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION

Garfield High SchoolYour senior has asked to attend our drug-and alcohol-free graduation vent (the “Graduation Event” or “Event”). The purpose of the

Graduation Event is to provide a fun, memorable experience that celebrates the seniors’ hard work. The Parent Planning Committee is

committed to keeping it safe, drug- and alcohol-free, and to ensure that the conduct of all seniors is in keeping with this goal. As a

condition of participation and in consideration of the services provided by the parents on the Parent Planning Committee; the Howard

Group, Inc., d/b/a Grad Nights, and its officers, owners, employees, agents, contractors, entertainers, and volunteers; and all other persons or entities acting in any capacity with respect to the event, including the venues who host and provide services at the

graduation event (hereinafter collectively referred to as the “Graduation Party Producers”), the senior and parent/guardian agree as

follows:

RULES AND PROHIBITED ITEMS SEARCH: All seniors and their personal belongings will be searched prior to their gaining entry

to this event. Senior and parent/guardian will abide by the rules and directions established by the Graduation Party Producers. Any

senior who is engaging in prohibited or undesirable behavior may be removed from the event, at the sole discretion of the Graduation

Party Producers, whereupon the parent/guardian will be contacted and must pick up their senior from the graduation event location.

No refunds will be granted.

SENIOR’S DAMAGE TO PROPERTY: The senior and their parent/guardian will pay the full replacement cost for any and all losses

or damage to any property that are directly or indirectly caused by the senior while participating in the Graduation Event.

AUTHORIZATION FOR MEDICAL CARE: In case of emergency, the senior and the parent/guardian of the senior named below

authorize all medical, surgical, diagnostic, and hospital procedures as may be deemed necessary and performed by a treating health

care provider.

USE OF LIKENESS: Senior and parent/guardian give full consent to Grad Nights to make and use photographs, videos, or likeness of

any senior attending this event for the purpose of advertising, publicizing, promoting, etc.

Additional important provisions and signature lines are on the reverse side of this document. Please read all the terms of this

agreement, provide the information requested in the contact information section below, and sign the reverse side of this form

acknowledging your agreement to all terms set forth on both sides of this document.

CONTACT INFORMATION

Page 6: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda

All information contained herein is strictly confidential, protected by copyright and intended for use only by the 2019 committee.

Use of this form, or any part or derivation by any committee, group or individual not currently working with Grad Nights is strictly prohibited.

© 1983-2016 Grad Nights. Grad Nights® is a registered trademark of The Howard Group, Inc.

Important Additional Provisions

1. ACTIVITIES AND ASSOCIATED RISKS: The Graduation Event may include a variety of entertainment, recreational, athletic

and sporting activities including activities using equipment provided by Graduation Party Producers including but not limited to

swimming pools, skating rinks, bowling centers, segways, bumper cars, go-karts, hypnotists, factor of fear shows, disc jockeys,

sumo wrestling, bungee runs, obstacle courses, pounce and bounces, velcro walls, climbing walls, henna, bungee/mechanical bull,

joust, slide, zip line, and other inflatables, and such activities and equipment are collectively referred to as “Recreational

Entertainment and Equipment”. Senior and parent/guardian acknowledge that participation in and use of Recreational

Entertainment and Equipment involve known, unknown, inherent and unanticipated risks, which could result in serious physical or

emotional injury, falls, muscle strains, broken bones and other potential injuries. These risks include, but are not limited to,

senior’s failure or failure of other participants to follow the safety guidelines or instructions of Graduation Party Producer’s

personnel; improper use of equipment; inadequate repair or maintenance of Graduation Party Producer’s facilities and equipment;

manufacturing or other defects, both apparent and latent, in the equipment supplied or used by Graduation Party Producers;

senior’s or other participants’ attempts to exceed their skills and/or act in a reckless manner; senior’s physical condition; improper

first-aid, emergency treatment or other attempted rescue services; the unavailability of medical services or immediate medical

attention in the case of injury; and acts or omissions of Graduation Party Producers, including insufficient instruction or assistance.

2. ASSUMPTION OF RISKS: Senior and parent/guardian expressly and freely accept and assume all of the risks relating to their

participation in the Graduation Event including but not limited to participation in and use of Recreational Entertainment and

Equipment. Senior and parent/guardian agree that senior’s participation in the Graduation Event and participation in and use of any

Recreational Entertainment and Equipment is purely voluntary, and that any participation is done in spite of the risks.

3. RELEASE OF LIABILITY/INDEMNIFICATION: Senior and parent/guardian each hereby release and covenant not to sue each

of the Graduation Party Producers, their owners, employees, agents, and any related affiliate and/or subsidiary entities (collectively

“Released Parties) from any and all claims, damages and liabilities of any nature arising out of the Graduation Event, including,

without limitation, personal injury, property damage, and claims of negligence based on acts or omissions of Released Parties, but

not including gross negligence or intentional misconduct or other liabilities not releasable by law. Senior and parent/guardian each

further agree to indemnify, defend and hold harmless Released Parties against any claims released in Section 3, against senior and

parent/guardian’s acts or omissions, and against any other claim or damage arising from senior’s participation in the Graduation

Event, including, without limitation, personal injury and property damage, and attorney’s fees and costs incurred to defend against

indemnified claims.

4. FOOD ALLERGIES: Senior and parent/guardian agree to abide by the Grad Nights life threatening food allergy policy and will

provide an Emergency Care Plan if senior has a life threatening food allergy. Additionally, senior and parent/guardian agree and

acknowledge that the Release of Liability and Indemnification provisions of this Agreement include claims and damages arising

out of senior’s consuming or handling of the food provided during the Graduation Event.

5. SEVERABILITY/ATTORNEYS FEES AND COSTS/APPLICABLE LAW: Should Graduation Party Producers or anyone acting

on their behalf incur attorneys’ fees and costs to enforce this Agreement, senior and parent/guardian further agree the prevailing

party shall be entitled to recovery of any such fees and costs. In the event that any portion of this Agreement is deemed invalid or

unenforceable, all other portions of this Agreement shall remain in full force and effect to the maximum extent allowed by law.

This Agreement is governed by the laws of the State of Washington.

6. OTHER: Senior and parent/guardian certify that senior has insurance to cover injury or damage senior may cause or suffer while

participating in the Graduation Event, and further agree that senior and parent/guardian will bear any uninsured costs of such injury

or damage themselves. Senior and parent/guardian further agree and warrant that senior has no medical or physical conditions

which could interfere with senior’s safe participation in the Graduation Event including participation in and use of any

Recreational Entertainment and Equipment and that senior will not engage in any activity which is inappropriate for senior given

any medical, physical or emotional condition of senior. In the event such conditions exist, senior and parent/guardian agree the risk

of senior’s participation in the Graduation Event and participation in and use of Recreational Entertainment and Equipment with

such condition is included in their assumption of risk under this Agreement and any damages and claims arising from participation

with such a condition are included within their commitments to release, indemnify, defend and hold harmless under this

Agreement.

By signing this Agreement Senior and parent/guardian are affirming that Senior and parent/guardian have had sufficient opportunity to

thoroughly read both sides of this document, and that they fully understand and agree to the terms set forth therein.

Senior’s Signature Date Parent/Guardian Signature Date

At Time of Party:

In the event that the senior has attained the age of majority (eighteen years of age), between the time that this document is initially

signed and the date of the graduation party, senior hereby reaffirms senior’s agreement to the terms of this agreement by re-

reading, signing and dating the line entitled “Adult Senior’s Signature Reaffirming Agreement”.

Adult Senior’s Signature Reaffirming Agreement Date

Page 7: Garfield Senior Class of 2019 - Grad Night Partygarfieldptsa.org/wp-content/uploads/2018/08/Grad-Night-Packet-2019.pdf · waxaa ku jira Baska,Cunnada,Madadaalada,iyo Hadyad ardayda

All information contained herein is strictly confidential, protected by copyright and intended for use only by the 2019 committee. Use of this form, or any part or derivation by any committee, group or individual not currently working with Grad Nights is strictly prohibited. © 2000-2016 Grad Nights. Grad Nights® is a registered trademark of The Howard Group, Inc.

Life–Threatening Food Allergy Emergency Care Plan (ECP) Student Information

Senior Name: Life-Threatening ALLERGY to:

Emergency Contact 1 (Full Name & Phone #): Emergency Contact 2 (Full Name & Phone #):

Senior should avoid contact with this/ these allergen(s):

Other allergies:

Will the senior be bringing separate food to the event? □ YES □ NOWill the senior be carrying an EpiPen on his or her person during the event? □ YES □ NO

School: Birthdate: Night-of-Event Bus #: Onsite help to enter day of event

Routine medications (at home/school):

Is it medically necessary for student to carry their own Epipen? □ YES □ NO

Asthmatic? □ YES □ NO

High Risk for life-threatening reaction? □ YES □ NO

Date of last reaction:

Please list the specific symptoms the student has experienced in the past.

□ MOUTH Itching, tingling, and/or swelling of the lips, tongue, or mouth□ SKIN Hives, itchy rash, and/or swelling about the face or extremities □ THROAT Sense of tightness in the throat, hoarsened and hacking cough□ GUT Nausea, stomach ache/abdominal cramps, vomiting and/or diarrhea □ LUNG Shortness of breath, repetitive coughing, and/or wheezing □ HEART “Thready” pulse, “passing out”, fainting, blueness, and pale□ GENERAL Panic, sudden fatigue, chills, fear of impending doom□ OTHER _____________________________________________________________________________

IF YOU SUSPECT A LIFE-THREATENING ALLERGIC REACTION TO FOOD, IMMEDIATELY ADMINISTER EPINEPHRINE AND CALL 911.

Student’s Standard Medication Doses EPIPEN (.03) □ Student May Administer: □ YES □ NO

EPIPEN JR. (0.15) □ Student May Administer: □ YES □ NO

ANTIHISTAMINE: ________________________CC / MG (circle one)

Repeat dose of EPIPEN: □ YES □ NO

If YES, when:

EpiPen Side Effects:

Give (list medication) _____________________________ _______ Teaspoons _______ Tablets by mouth

Other Medication Side Effects:

I agree to notify the Planning Committee of any changes to the above information between now and the date of graduation.

By:_______________________________________ (Parent/Guardian’s Signature)

Date:______________

Action Plan if an Allergic Reaction Occurs During the Event 1. Administer Epinephrine AND CALL 911 (DO NOT HESITATE to administer Epinephrine).2. 911 MUST BE CALLED IF EPINEPHRINE IS ADMINISTERED.3. Advise 911 that the student is having a life-threatening allergic reaction AND Epinephrine is being administered.

REQUEST ADVANCED LIFE SUPPORT.4. Note the time of Epinephrine administration: _______________ AM / PM5. Place Epipen in the container provided AND send with emergency responders along with ECP.6. Call Parents or other emergency contacts.

Signature of Emergency Responders: __________________________________ Date:________________

Printed Name of Emergency Responders: ___________________________________________________

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