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PATRIOT HIGH SCHOOL
PROM 2015 GUEST CONTRACT
Name of Patriot Student Purchasing Tickets: ________________________________ Grade: ________________
Name of Guest: _____________________________________________________________________
Guest (non-Junior or –Senior Patriot High School student): Please read and sign the section below, record the
name of the last high school you attended, record the name of the college you are attending (if applicable). All
guests must be under the age of 20.
I, ________________________________________________, agree to respect and abide by all the school rules,
regulations and policies of Patriot High School while I am a Guest at PHS Prom on MAY 16TH, 2015.
Last High School Attended:
_______________________
College Attending (If applicable): _______________________
***Patriot Student Parent’s Signature: __________________________________________
***Patriot Student Parent’s Phone Number: ______________________________________
High School Guest: Please give this form to your high school administrator. The School Administrator
section must be completed and returned to you.
School Administrator: Please indicate the status of this student at your high school, then sign and return this form to
the student in an enclosed envelope. If you have any questions, please call 703-594-3020.
____________
This student is in good standing at our school.
____________
This student is NOT in good standing at our school.
____________
Please contact me regarding this student.
Administrator: _________________________________ Signature: _______________________________________
(Please print)
Telephone Number: _________________________
School Name: ______________________________________
This form must be completed BEFORE purchasing a guest ticket.
Guest Forms must be submitted (to the Main Office) NO LATER THAN May 8th, 2015.
Guest admission to the dance is contingent on approval by Mr. Lavely. If your guest is
unable to attend the dance, you will be notified.