Student and Guest Acknowledgement Form for 2013 PROM

ACKNOWLEDGEMENT/GUEST FORM
West Potomac High School Student and Guest JUNIOR AND SENIOR PROM 2013
The West Potomac High Junior and Senior Prom will be held at Hilton Alexandria Mark Center, Friday, June 7, 2013. There will
be NO REFUNDS. This form must be filled out completely by each student and returned to the Co-Class Sponsor Mrs. Corbett
at the time of ticket purchase. ALL guest forms are due in Ms. Corbett’s mail box on or before 5/31/2013. Mrs. Corbett can
be reached at 703-718-2500 if there are any questions and/or concerns. Read all information carefully.
Where: Hilton Alexandria Mark Center, 5000 Seminary Road, Alexandria, Va. 22311
When: Friday, June 7, 2013
Time: 7:00 PM to MIDNIGHT
Pricing See below
DATES SOLD
PRICES
January $50.00
February $55.00
March $60.00
April $65.00
May - June $70.00
Price includes; Admission, DJ, dessert and drinks. Parking is complementary
PICTURE I.D. IS REQUIRED to gain admission to dance. All students must have a current I.D. card from their school/college.
Guests that have finished school must have a driver’s license or other picture I.D. FAILURE TO BRING A PICTURE I.D. TO THE
DANCE will result in not being admitted to dance.
Ticket Policy
1. All obligations must be cleared prior to purchasing tickets.
2. All tickets are numbered and sold to specific individuals with signed Acknowledgement/Guest form.
3. All tickets must be purchased from the Prom committee. Tickets may NOT be given, sold, or exchanged to other students.
4. Each student is allowed to purchase a maximum of two tickets; one for him/himself and one for a guest.
5. Guest is permitted into event only in the company of the West Potomac student sponsor and must leave when the sponsor leaves.
6. WPHS student is responsible for the guest at all times and may be disciplined for the actions of their guest.
7. All WPHS rules of conduct apply to guest.
8. The person who purchased the tickets may change “date” if 1) he/she informs the other person no longer attending and 2) he/she
turns in assigned Acknowledgement/Guest form from their new “date”.
9. NO REFUNDS will be given to students who do not show up for any reason ( including suspension from school) or are not allowed
to enter due to improper behavior, dress code violation, or use/possession of alcohol, tobacco, or drugs
10. West Potomac High School administration reserves the right to refuse permission to any person to attend any event sponsored by
West Potomac.
Dance Rules:
1. You and your guest are not to use profane language, drugs, alcoholic beverage or tobacco. All individuals attending the event will
subject to search by members of the event security service.
2. Students dancing or behaving inappropriately will be escorted out of the dance and will not be given a refund. This includes any
sexually explicit or violence-oriented dancing commonly known as freaking, moshing, battling, or grinding *NO TOUCHING IF
DANCING BACK TO FRONT; *NO TOUCHING BREASTS, BUTTOCKS, OR GENTALS; * NO STADDLING EACH OTHERS LEGS; *BOTH FEET
ON THE FLOOR. Students who are asked to leave the dance will lose the next dance or senior event and other disciplinary action
may be taken. Parent will be notified.
3. Any student who is on suspension or expulsion may not attend WPHS dance/event. You must completely fill out the
Acknowledgement/Guest form, have it approved and turn in at time that you purchase your tickets. You must purchase your
ticket and your guest’s tickets at the same time. You and your guest must check in at the dance at the same time with dance
tickets and picture I.D. cards. NO TICKETS & NO PICTURE I.D. = NO ADMISSION
4. Guests from another school must not have been removed or transferred for discipline reasons from WPHS. Guests must be high
school age or older.
5. Guests must be in good standing at their home school and not be suspended at the time of the dance. Guest must have their
school administrator approve and sign our Acknowledgement/Guest form.

6. Parents and students should understand that there are NO REFUNDS.
7. No one leaving the dance will get re-admitted.
8. It is important to remind you that the basic concepts of the school dress code policy will be enforced. Attire that is overly
revealing, low cut, or excessively sheer is not appropriate for any school activity. Please keep this mind when renting or
purchasing your attire. It would be most unfortunate to spoil your high school experience through poor choice in dance attire and
be asked to leave the event. Please choose wisely and check with school administrator if you are in doubt. No props are allowed
at any of the dances.
9. GUEST MUST BE 21 AND UNDER IN AGE.
10. Any violation of school rules will result in discipline in accordance with school policy and possibly your immediate removal from
the dance. NO Refunds.
WEST POTOMAC HIGH SCHOOL STUDENT COMPLETE:
I have read, understood and will comply with all provisions of the Agreement.
Date: __________
_________________________________ _____________ ___________ __________________
Print Student Name Student No. Student Grade Student Signature
_________________________________
Print Parent Name
___________________________________
Parent Signature
Telephone number at which the parent may be reached during the evening: ____________________________
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A) GUESTS WHO ARE NOT CURRENT STUDENTS AT WPHS MUST COMPLETE THE FOLLOWING GUEST APPLICATION AND
SUBMIT A COPY OF HIS/HER CURRENT PICTURE ID OR DRIVER’S LICENSE BEFORE TICKET PURCHASE
I have read, understood and will comply with all provisions of the Agreement.
Date: ____________
___________________________________ ___________ __________ _________ _________________
Print Guest Name Grade/Year Guest Birthday Guest Age Guest Signature
________________________ ___________________ _________________________
Guest Address City/State/Zip Code Guest Emergency Phone No.
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B)
___________________________________________
Name of Guest’s Parent/ Employer/College Advisor/Other
______________________________________________
Signature of Guest’s Parent/ Employer/College Advisor/Other
SCHOOL NAME: _____________________ OR Place of Employment: ____________________________
__________________________________
Signature of Guest’s School Administrator/Supervisor
______________________
Date
__________________________________
Phone Number/Extension
C)
___________________: APPROVED
___________________: DENIED/REASON
___________________: WPHS ADMINISTRATOR’S SIGNATURE
___________________: Date