High School Dance Guest Form printable pdf download

Mahomet-Seymour High School

Dance Request Form

Instructions: A student requesting to bring a date who is not a Mahomet-Seymour High School student

must have this form completed and returned at least three days before the event. This form requires the

signature of the principal or administrator of the guest's school. The guest must provide a driver’s

license with photo ID at the dance entrance.

As a MSHS student, I understand that all MSHS rules apply at any school function. I am also aware that

once my date and I leave the dance, we will not be allowed reentry for any reason. I understand that

neither my guest nor I may be under the influence of drugs or alcohol during this activity. The use of/or

possession of tobacco products is not allowed at any school activity. I will take full responsibility to

inform and ensure my date's compliance to all school rules while attending the dance. The guest must

always have photo identification in his/her possession and must not be older than 20 years of age, or

younger than a current 9th grader in school.

_________________________________

____________________________

Name of Dance

Date of Dance

_________________________________

____________________________

Name of MSHS Student

Grade

_________________________________

____________________________

Signature of MSHS Student

Date

As the parent of the above MSHS student I find his/her date to be a responsible person and I approve

him/her as an acceptable guest for this MSHS social event.

_________________________________________

___________________________

Parent/Guardian Signature of MSHS Student

Date

GUEST INFORMATION (PLEASE PRINT)

Name _________________________________

Age (As of date of event) ________

Address _______________________________

Phone _______________________

School/City ______________________________________________________________

If not a student, list employer and phone number

_____________________________________

_____________________________

Employer

Phone

As the Principal/Administrator of the school that this potential visitor to MSHS attends, I verify he/she is a

student in good standing.

_______________________________

______________________ ____________

Name of Administrator

Title

Phone

_______________________________

______________________

Signature of Administrator

Date

**Any false representation of information provided on this sheet will result in the guest being prohibited

from attendance at this specific event**

OFFICE USE ONLY

Approved__________________________

Not Approved___________________________

Administrator Signature

High School Dance Guest Form

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