Randolph High School Class of 2017

Junior Prom Guest Form

The Skylands

Randolph, NJ

Friday, May 13, 2016

Name of Student: ______Date of Birth: ______

Name of Guest: ______Date of Birth: ______

(Copy of Driver’s license or other Valid I.D. must be attached to this form)

Parent’s Name: ______

Phone # for Parent DURING THE EVENT: ______

Emergency Contact Name: ______

Emergency Contact #: ______

It is understood and hereby agreed to by the parent and student whose name and signature appear below that:

  • The Prom is a school sponsored event for which all school rules and policies apply and will be strictly enforced. Attendance at the prom is a privilege not a right.
  • Students are subject to removal from the prom, disciplinary action and referral to law enforcement (for criminal activity) for any disciplinary infraction, including but not limited to smoking, drinking, beingunder the influence of alcohol/controlled dangerous substances, fighting, insubordination, inappropriate dress/clothing, unsafe acts, or illegal activity. No student may bring a guest who is over the age of twenty (20) to the prom.
  • Randolph students are fully responsible for the actions of their guests who are from other townships or municipalities.
  • Students will be held liable for any damage done to the transportation vehicles, school property or the prom venue.
  • Guest students must have their student ID with them at all times.
  • Tickets for this event are nontransferable.
  • No Refunds

______

PRINTED Name of Randolph Student Signature of Randolph student

______

PRINTED Name of Guest Signature of Guest

______

PRINTED Name of Randolph Parent Signature of Guest’s Parent

The following section (page 2) is to be completed by school administration

of the Guest and returned by Friday, April 15th, 2016.

Name of student: ______Name of RHS student: ______

Please FAX or mail this page to RHS by Friday April15th

The above named student has been invited by a Randolph High School student to attend our JuniorProm onFridayMay 13th, 2016. Please complete the following so we may know more about the guest.Please return this to the guest in a SEALED school envelope, OR fax it to Randolph High School at 973-361-1661, attention Mrs. Dixon orMs. Valvano, Class of 2017 Class Advisors.

What is this person’s status at your school?

______Current student ______Former student ______Graduate

If a current student, is he/she in good standing at your school? Yes______No______

If a former student or graduate, what year did he/she last attend your school? ______

If your school had a special event tonight, would you allow this person to attend? Yes_____ No _____

Does he/she have a record of disciplinary infractions, violence and/or use of weapons on your school property? Yes _____ No ____ If yes, please explain:

Do you know of any reason why this person should be excluded as a guest at our prom? Yes _____ No ____

If “YES” to either of the last two questions, please explain more specifically below:

______

Name of School Your Name (print please)

______

Your Email Address Your phone number

______

Your Signature

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