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Lee’s Summit North High School
PROM Out of School Dance Guest Request
(Prom is Saturday, May 2, 2015)
This form must be turned in to the main office or faxed in by:
Wednesday, April 29, 2015
Instructions:
1) Review guest eligibility requirements below.
2) Complete the LSNHS student information.
3) Give this form to your guest and have them give to their administrator.
4) Guest’s school will then fax the form to LSN.
Dance Guest Eligibility Requirements:
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Out of school guests of LSN students will not be allowed to attend this dance if not received by the
deadline date stated above.
Only one guest per one LSN student is allowed.
Out of school guests must provide their school ID or a valid picture ID such as a drivers license at the
time of admittance to the dance. LSN student must present their LSN student ID at the time of
admittance to dance.
All dance guests must be a minimum age attendance of the classification of a freshman in high
school.
All dance guests must not have reached the age of 21.
LSNHS student please fill out the following:
(Please print clearly)
LSNHS Student’s Name: ________________________________________ Grade: _______
Guest’s Name: _________________________________________________ Grade: _______
Guest’s School: ______________________________________________________________
[If not in high school, list most recent school attended]
Guest’s Age: _____________
Guest Student’s Administrator/ Principal please fill out and fax:
Please place a check in the appropriate space.
_____Yes, the guest student from my school is/was a person of good citizenship and character.
_____No, the guest student from my school has/did not exhibits good citizenship and character.
________________________________________
Administrator’s Signature
Guest student administrator please Fax to 816-986-3170
Revised March 19, 2012