Grad Bash 2023 Permission and Payment

Note: This form and payment are due no later than Wednesday, March 8.
Student Namerequired
First Name
Last Name
My child will attend Grad Bash.required
My child will need to take medication during the event.required
I understand my child must give his/her medication to Ms. Kiser before boarding the bus.required
Your Namerequired
First Name
Last Name


By typing my electronic signature below, I give permission for my child to attend Grad Bash at Universal Studios on April 21.

I authorize my credit card to be charged $135, which includes a 3% credit card processing fee.

Payment Information

Provide an email address for the receipt.
Please select a payment typerequired
Billing Addressrequired
Cardholder Namerequired