Student and Guest Acknowledgement Form for 2013 PROM
Student and Guest Acknowledgement Form for 2013 PROM
Student and Guest Acknowledgement Form for 2013 PROM
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ACKNOWLEDGEMENT/GUEST FORM<br />
West Potomac High School <strong>Student</strong> <strong>and</strong> <strong>Guest</strong> JUNIOR AND SENIOR <strong>PROM</strong> <strong>2013</strong><br />
The West Potomac High Junior <strong>and</strong> Senior Prom will be held at Hilton Alex<strong>and</strong>ria Mark Center, Friday, June 7, <strong>2013</strong>. There will<br />
be NO REFUNDS. This <strong>for</strong>m must be filled out completely by each student <strong>and</strong> returned to the Co-Class Sponsor Mrs. Corbett<br />
at the time of ticket purchase. ALL guest <strong>for</strong>ms are due in Ms. Corbett’s mail box on or be<strong>for</strong>e 5/31/<strong>2013</strong>. Mrs. Corbett can<br />
be reached at 703-718-2500 if there are any questions <strong>and</strong>/or concerns. Read all in<strong>for</strong>mation carefully.<br />
Where: Hilton Alex<strong>and</strong>ria Mark Center, 5000 Seminary Road, Alex<strong>and</strong>ria, Va. 22311<br />
When: Friday, June 7, <strong>2013</strong><br />
Time: 7:00 PM to MIDNIGHT<br />
Pricing See below<br />
DATES SOLD<br />
PRICES<br />
January $50.00<br />
February $55.00<br />
March $60.00<br />
April $65.00<br />
May - June $70.00<br />
Price includes; Admission, DJ, dessert <strong>and</strong> drinks. Parking is complementary<br />
PICTURE I.D. IS REQUIRED to gain admission to dance. All students must have a current I.D. card from their school/college.<br />
<strong>Guest</strong>s that have finished school must have a driver’s license or other picture I.D. FAILURE TO BRING A PICTURE I.D. TO THE<br />
DANCE will result in not being admitted to dance.<br />
Ticket Policy<br />
1. All obligations must be cleared prior to purchasing tickets.<br />
2. All tickets are numbered <strong>and</strong> sold to specific individuals with signed <strong>Acknowledgement</strong>/<strong>Guest</strong> <strong>for</strong>m.<br />
3. All tickets must be purchased from the Prom committee. Tickets may NOT be given, sold, or exchanged to other students.<br />
4. Each student is allowed to purchase a maximum of two tickets; one <strong>for</strong> him/himself <strong>and</strong> one <strong>for</strong> a guest.<br />
5. <strong>Guest</strong> is permitted into event only in the company of the West Potomac student sponsor <strong>and</strong> must leave when the sponsor leaves.<br />
6. WPHS student is responsible <strong>for</strong> the guest at all times <strong>and</strong> may be disciplined <strong>for</strong> the actions of their guest.<br />
7. All WPHS rules of conduct apply to guest.<br />
8. The person who purchased the tickets may change “date” if 1) he/she in<strong>for</strong>ms the other person no longer attending <strong>and</strong> 2) he/she<br />
turns in assigned <strong>Acknowledgement</strong>/<strong>Guest</strong> <strong>for</strong>m from their new “date”.<br />
9. NO REFUNDS will be given to students who do not show up <strong>for</strong> any reason ( including suspension from school) or are not allowed<br />
to enter due to improper behavior, dress code violation, or use/possession of alcohol, tobacco, or drugs<br />
10. West Potomac High School administration reserves the right to refuse permission to any person to attend any event sponsored by<br />
West Potomac.<br />
Dance Rules:<br />
1. You <strong>and</strong> your guest are not to use profane language, drugs, alcoholic beverage or tobacco. All individuals attending the event will<br />
subject to search by members of the event security service.<br />
2. <strong>Student</strong>s dancing or behaving inappropriately will be escorted out of the dance <strong>and</strong> will not be given a refund. This includes any<br />
sexually explicit or violence-oriented dancing commonly known as freaking, moshing, battling, or grinding *NO TOUCHING IF<br />
DANCING BACK TO FRONT; *NO TOUCHING BREASTS, BUTTOCKS, OR GENTALS; * NO STADDLING EACH OTHERS LEGS; *BOTH FEET<br />
ON THE FLOOR. <strong>Student</strong>s who are asked to leave the dance will lose the next dance or senior event <strong>and</strong> other disciplinary action<br />
may be taken. Parent will be notified.<br />
3. Any student who is on suspension or expulsion may not attend WPHS dance/event. You must completely fill out the<br />
<strong>Acknowledgement</strong>/<strong>Guest</strong> <strong>for</strong>m, have it approved <strong>and</strong> turn in at time that you purchase your tickets. You must purchase your<br />
ticket <strong>and</strong> your guest’s tickets at the same time. You <strong>and</strong> your guest must check in at the dance at the same time with dance<br />
tickets <strong>and</strong> picture I.D. cards. NO TICKETS & NO PICTURE I.D. = NO ADMISSION<br />
4. <strong>Guest</strong>s from another school must not have been removed or transferred <strong>for</strong> discipline reasons from WPHS. <strong>Guest</strong>s must be high<br />
school age or older.<br />
5. <strong>Guest</strong>s must be in good st<strong>and</strong>ing at their home school <strong>and</strong> not be suspended at the time of the dance. <strong>Guest</strong> must have their<br />
school administrator approve <strong>and</strong> sign our <strong>Acknowledgement</strong>/<strong>Guest</strong> <strong>for</strong>m.
6. Parents <strong>and</strong> students should underst<strong>and</strong> that there are NO REFUNDS.<br />
7. No one leaving the dance will get re-admitted.<br />
8. It is important to remind you that the basic concepts of the school dress code policy will be en<strong>for</strong>ced. Attire that is overly<br />
revealing, low cut, or excessively sheer is not appropriate <strong>for</strong> any school activity. Please keep this mind when renting or<br />
purchasing your attire. It would be most un<strong>for</strong>tunate to spoil your high school experience through poor choice in dance attire <strong>and</strong><br />
be asked to leave the event. Please choose wisely <strong>and</strong> check with school administrator if you are in doubt. No props are allowed<br />
at any of the dances.<br />
9. GUEST MUST BE 21 AND UNDER IN AGE.<br />
10. Any violation of school rules will result in discipline in accordance with school policy <strong>and</strong> possibly your immediate removal from<br />
the dance. NO Refunds.<br />
WEST POTOMAC HIGH SCHOOL STUDENT COMPLETE:<br />
I have read, understood <strong>and</strong> will comply with all provisions of the Agreement.<br />
Date: __________<br />
_________________________________ _____________ ___________ __________________<br />
Print <strong>Student</strong> Name <strong>Student</strong> No. <strong>Student</strong> Grade <strong>Student</strong> Signature<br />
_________________________________<br />
Print Parent Name<br />
___________________________________<br />
Parent Signature<br />
Telephone number at which the parent may be reached during the evening: ____________________________<br />
----------------------------------------------------------------------------------------------------------------------------------------------------<br />
A) GUESTS WHO ARE NOT CURRENT STUDENTS AT WPHS MUST COMPLETE THE FOLLOWING GUEST APPLICATION AND<br />
SUBMIT A COPY OF HIS/HER CURRENT PICTURE ID OR DRIVER’S LICENSE BEFORE TICKET PURCHASE<br />
I have read, understood <strong>and</strong> will comply with all provisions of the Agreement.<br />
Date: ____________<br />
___________________________________ ___________ __________ _________ _________________<br />
Print <strong>Guest</strong> Name Grade/Year <strong>Guest</strong> Birthday <strong>Guest</strong> Age <strong>Guest</strong> Signature<br />
________________________ ___________________ _________________________<br />
<strong>Guest</strong> Address City/State/Zip Code <strong>Guest</strong> Emergency Phone No.<br />
-------------------------------------------------------------------------------------------------------------------------------------------------------------------<br />
B)<br />
___________________________________________<br />
Name of <strong>Guest</strong>’s Parent/ Employer/College Advisor/Other<br />
______________________________________________<br />
Signature of <strong>Guest</strong>’s Parent/ Employer/College Advisor/Other<br />
SCHOOL NAME: _____________________ OR Place of Employment: ____________________________<br />
__________________________________<br />
Signature of <strong>Guest</strong>’s School Administrator/Supervisor<br />
______________________<br />
Date<br />
__________________________________<br />
Phone Number/Extension<br />
C)<br />
___________________: APPROVED<br />
___________________: DENIED/REASON<br />
___________________: WPHS ADMINISTRATOR’S SIGNATURE<br />
___________________: Date