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“Moulin Rouge”
Marina High School – Prom
Saturday, May 16, 2015
8:00 pm – 12:00 am
As the parent or guardian of the student named below, I have carefully reviewed and discussed the
event guidelines with my child, and we agree to abide by all of them. I understand there are no
refunds. This includes students who may be suspended or cited for discipline issues.
MHS Student (please print your name)
MHS Student Signature
Grade /Your Student ID #
MHS Parent Name (please print your name)
MHS Parent Signature
Emergency Phone #
MHS Guest Student (please print your name)
MHS Guest Student Signature
Grade /Your Student ID #
MHS Guest Parent Name (please print your name)
MHS Guest Parent Signature
Emergency Phone #
MHS Student/MHS Guest MUST have a current school ID to enter the dance.
NO EXCEPTIONS! Once a ticket is purchased, refunds will not be granted.
This completed Contract must be approved in Room 301 before you purchase your ticket
NON MARINA GUESTS ONLY NEED TO
FILL IN INFORMATION BELOW!!
 An administrator’s signature in the space provided below AND a business card attached.
 Guest’s parent and guest signatures
If your guest attends another high school, please provide the following information:
Non Marina High School Guest's Name (please print your name)
High School in attendance
Non Marina Guest Signature
High School phone number
Non Marina Guest Parent name and Signature
This affirms that this student is in good standing and should
not be a disciplinary problem at the MHS dance (to be
signed by guest’s school administrator)
Phone numbers where parents can be reached May 16, 2015
Name (please print)
(
)
Signature
(
)
Please attach a business card.
***Guests 21 years or older are not allowed at dances***
If your guest does not attend high school, please provide the following information:
Non High School Guest Name (please print)
Non High School Guest’s Emergency Contact phone number
Guest’s age as of May 16, 2015
I, the guest, understand the rules that apply to this MHS
event and I will adhere to these rules.
Please attach a copy of your current photo ID (driver’s
Signature
license, college student ID, etc.)
Marina High School
“Moulin Rouge”
Prom 2015
LA Center Studios
1201 W 5th St T-110
Los Angeles, CA 90017
Saturday, May 16, 2015
8:00 pm – 12:00 am
ONE DAY ONLY!!! Friday, May 1: $120 Couples Ticket
$60 Singles Ticket
COUPLES TICKET
w/ ASB
w/o ASB
$140
$160
$150
$170
May 4 – 8
May 11 – 14
SINGLES TICKET
w/ ASB
w/o ASB
$70
$80
$75
$85
Last Day Price!!! May 15: $180 (Couples) --- $90 (Singles)
DRESS CODE: Casual Dress – School dress code applies.
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BOYS: Tuxes or suit, dress slacks, shirt and tie.
GIRLS: Long or short dress/gown, dress or skirt, “After six-formal” attire. No “extreme” revealing clothing
Shoes must be worn.
Any student inappropriately dressed will be asked to go home and change.
Please check with administration prior to the dance if you have any concerns regarding appropriate dance attire.
Bring the following to the financial office window to
purchase a ticket:
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Current ID card
Cash or credit card
This completed contract with the approval stamp
GENERAL INFORMATION:
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Trading or selling tickets is not allowed and may cause ticket holder to be turned away at the door. All Marina
students must have their current (2014-2015) school identification card. Guests who are not Marina
students must present a photo I.D. (i.e. driver’s license).
Students will not be admitted after 10pm. Students or guests who leave the dance during the evening will not
be readmitted.
BEHAVIOR EXPECTATIONS:
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Any student or guest suspected of using alcohol or any controlled substance at or prior to the event (or in the
parking lot) will be denied admittance or removed from the dance. Parents and/or police will be called. A
breathalyzer will be used to test students at the discretion of the administration. All students will be
subject to a search. We reserve the right to search any vehicle.
Students who purchase tickets are required to inform their guests of all contract rules. Any student or guest
exhibiting disruptive behavior will be removed along with their escort.
At the discretion of Administration, students who violate any school rule or the terms of this contract will be
suspended and/or expelled and excluded from all dances for the remainder of the school year. Parents will be
called and student will be immediately removed.