LAKE HIGH SCHOOL 1025 LAKE CENTER STREET NW UNIONTOWN, OHIO 44685 (330) 877-4282
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OUT OF SCHOOL GUEST APPLICATION
Lake High School Function JUNIOR-SENIOR PROM Location The McKinley Grand
Date/Time Saturday, May 5,2018 5:45 p.m. – 10:00 p.m.
Lake students wishing to bring one non-Lake student guest to the above Lake High School function must receive approval from the Lake High School administration. This completed form must be submitted to the high school administration and approved before purchasing tickets to this function.
All Lake High School rules will be in effect at this function and are applicable to both our student and the guest. After entering the building, no one will be permitted to leave the building and return to the dance.
** Please note that no middle school students, 9th graders, or persons over twenty (20) years of age will be permitted at this function.
------LAKE STUDENT INFORMATION
Name ______Age _____ Grade _____ Phone # ______
Parent/Guardian Name(s) ______
I understand that I am subject to Lake High School disciplinary action based on the behavior and actions of myself and the actions of my non-Lake High School student guest.
Student Signature ______Date ______
Parent/Guardian Signature ______Date ______
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NON-LAKE HIGH SCHOOL STUDENT INFORMATION/RESPONSIBILITY STATEMENT
Name ______Grade ______Age ______
Address ______Home Phone # ______
Parent/Guardian Name(s) ______
High School/College Attending ______
High School Attended ______Year of Graduation ______
High School Telephone Number ______
I understand that I am subject to all Lake High School rules and responsibilities. I furthermore understand that my Lake High School escort is equally subject to disciplinary actions based on my behavior and actions.
Guest Signature ______Date______
My son/daughter has my permission to participate in the function listed above. I understand that I am ultimately responsible for his/her actions and behaviors. I permit Lake High School and Lake Local School staff and administration to take any actions necessary to maintain orderly conduct at this function.
Parent/Guardian of Guest Signature ______Date ______
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AFFIRMATION STATEMENT FROM PRINCIPAL OF GUEST STUDENT
By affixing my signature and school seal, I hereby attest that the student applying for out-of-school guest approval has maintained acceptable standards of behavior, attendance, and academic performance.
Principal’s Signature______Date ______
** PLEASE NOTE: Violations of Lake dress code or any inappropriate dancing or behavior will result in immediate removal from the premises and possible future disciplinary action.