1. education
2. school

AROUND
the
WORLD
OLSH Homecoming Dance (SUNDAY, October 12th) Reservation Packet
(Please print.)
Student Name______________________ Grade_____ HR #__________ Age_____ School OLSH
Guest Name_______________________ Grade_____ Age_____ School _____________________
(If Applicable)
(High School, College, or Employer Name)
Check One: pReservation(s) TURNED IN by FRIDAY, September 26th @ $30 each
pReservation(s) TURNED IN September 27th through October 3rd @ $35 each
TOTAL AMOUNT Enclosed $___________ (exact cash or check(s) payable to OLSH)
•Please complete this Reservation Packet and enclose exact cash or check(s) payable to OLSH.
•OLSH Students must complete permissions slips since the venue (The Club at Shadow Lakes) is off
school campus.
•If guest is a non-OLSH student, OLSH parents are responsible for approving of their child’s guest by
completing the “for NON-OLSH STUDENTS ONLY” permission slip. A COPY of photo ID must be returned with permission slip. Students younger than 9th grade are NOT permitted to attend. No guest
may be older than 20 years old.
•FINAL MORNING to TURN IN RESERVATIONS is FRIDAY, OCTOBER 3rd.
•Appropriate attire is required (see enclosed “Modesty Calculator”). Bare feet are not permitted.
•Pictures are an additional fee to be paid on dance night.
•There is no charge for parking at the venue.
•Students MUST attend school “on time” on Monday, October 13th.
INCOMPLETE RETURNS WILL NOT BE ACCEPTED!
Our Lady of the Sacred Heart
High School
1504 Woodcrest Avenue, Coraopolis, PA 15108-3054
Phone: (412) 264-5140 • FAX: (412) 264-4143
www.olsh.org • [email protected]
• H/C SEMI PERMISSION FORM •
for OLSH STUDENTS ONLY
I/We, the undersigned Parent(s) or Guardian of _____________________________________ (name of child),
a student at Our Lady of the Sacred Heart High School in Grade ________, give our/my permission for my/our
child to participate in the OLSH Homecoming Dance sponsored by OLSH Student Government & Spirit
Committee at The Club at Shadow Lakes on the 12th day of October, 2014, from 6:30 pm until 10:00 pm.
I/We understand that this is a supervised activity. I/We understand that my child will be chaperoned by a
responsible adult, who will take reasonable precautions to protect my child from harm and injury. My child will
act respectfully to all adults (including but not limited to, chaperones, d.j., security, venue staff). To maintain
order, students will be expected to comply with rules, standards, and instructions for student behavior,
including (but not limited to) dancing appropriately. My/our child (and guest, if applicable) will also wear
semi-formal attire that follows the SPECIFICATIONS for OLSH FORMAL EVENTS and is representative
of our Catholic School. I/We waive and release all claims against OLSH or their agents arising out of my
child’s failure to remain under such supervision. If at any time my child’s behavior is incompatible with the
standard for student behavior, his/her further participation may not be permitted.
In the event that my child is injured, becomes ill, or involved in an accident while away, I/we understand that
the chaperone will seek medical attention for my child and contact me/us as soon as possible, and that I/we will
be financially responsible for medical treatment. I/we further agree to hold OLSH, its employees, and agents
harmless for any injury or illness caused by the negligence of persons other than employees or agents of OLSH
when such injury or illness occurs during the event.
For OLSH students bringing a guest who does NOT attend OLSH, they must be in at least 9th grade and no
older than 20 years old. If the rules and regulations are violated by my child and/or their guest, I/we will escort
them from the Semi-Formal.
__________________ Date
____________________________ Phone Number (7:00 to 10:30 pm)
_____________________________________
Father Signature*
__________________ Date
____________________________ Phone Number (7:00 to 10:30 pm)
_____________________________________
__________________ Date
____________________________ Phone Number (7:00 to 10:30 pm)
_____________________________________
Guardian Signature*
Agreed Upon by Student______________________________________________________ (Student Signature)
Permission slips MUST accompany reservation envelope and payment. Incomplete returns will not be accepted.
Our Lady of the Sacred Heart
High School
1504 Woodcrest Avenue, Coraopolis, PA 15108-3054
Phone: (412) 264-5140 • FAX: (412) 264-4143
www.olsh.org • [email protected]
• H/C SEMI PERMISSION FORM •
for OLSH STUDENTS ONLY
I/We, the undersigned Parent(s) or Guardian of _____________________________________ (name of child),
a student at Our Lady of the Sacred Heart High School in Grade ________, give our/my permission for my/our
child to participate in the OLSH Homecoming Dance sponsored by OLSH Student Government & Spirit
Committee at The Club at Shadow Lakes on the 12th day of October, 2014, from 6:30 pm until 10:00 pm..
I/We understand that this is a supervised activity. I/We understand that my child will be chaperoned by a
responsible adult, who will take reasonable precautions to protect my child from harm and injury. My child will
act respectfully to all adults (including but not limited to, chaperones, d.j., security, venue staff). To maintain
order, students will be expected to comply with rules, standards, and instructions for student behavior,
including (but not limited to) dancing appropriately. My/our child (and guest, if applicable) will also wear
semi-formal attire that follows the SPECIFICATIONS for OLSH FORMAL EVENTS and is representative
of our Catholic School. I/We waive and release all claims against OLSH or their agents arising out of my
child’s failure to remain under such supervision. If at any time my child’s behavior is incompatible with the
standard for student behavior, his/her further participation may not be permitted.
In the event that my child is injured, becomes ill, or involved in an accident while away, I/we understand that
the chaperone will seek medical attention for my child and contact me/us as soon as possible, and that I/we will
be financially responsible for medical treatment. I/we further agree to hold OLSH, its employees, and agents
harmless for any injury or illness caused by the negligence of persons other than employees or agents of OLSH
when such injury or illness occurs during the event.
For OLSH students bringing a guest who does NOT attend OLSH, they must be in at least 9th grade and no
older than 20 years old. If the rules and regulations are violated by my child and/or their guest, I/we will escort
them from the Semi-Formal.
__________________ Date
____________________________ Phone Number (7:00 to 10:30 pm)
_____________________________________
Father Signature*
__________________ Date
____________________________ Phone Number (7:00 to 10:30 pm)
_____________________________________
__________________ Date
____________________________ Phone Number (7:00 to 10:30 pm)
_____________________________________
Guardian Signature*
Agreed Upon by Student______________________________________________________ (Student Signature)
Permission slips MUST accompany reservation envelope and payment. Incomplete returns will not be accepted.
• SEMI-FORMAL REQUEST & CONSENT FORM •
for NON-OLSH STUDENTS ONLY
Our Lady of the Sacred Heart
High School
1504 Woodcrest Avenue, Coraopolis, PA 15108-3054
Phone: (412) 264-5140 • FAX: (412) 264-4143
OLSH SEMI-FORMAL HOMECOMING DANCE • SUNDAY, OCTOBER 12th @ SHADOW LAKES
Our Lady of the Sacred Heart Student (name)____________________________________________________
Guest of OLSH Student (name)_______________________________________________________________
Guest Current School Attending_______________________________________________________________
Guest Grade Level_________________________________________________________________________
Guest Home Address________________________________________________________________________
Guest Home Phone____________________________ Guest Personal Cell Number____________________
The above guest has been invited to our Homecoming Semi-Formal Dance by your child. This guest must conform
to OLSH’s Specifications for Formal Events and Dance Rules and Expectations according to the OLSH ParentStudent Handbook, and your signature below confirms that you approve of this guest and will personally hold them to
the standards set by OLSH. Guests younger than 9th grade are NOT permitted to attend. No guest may be older than
20 years old. If a guest is asked to leave for any reason, the OLSH host must also leave with a parental escort. If you
have any questions, please call our Main Office at 412/264-5140. Please return this signed consent form, along with
a copy of photo ID, in the envelope provided when placing dance reservations.
Sincerely,
Mr. Timothy J. Plocinik
Principal
!
RE
!
E
E
H
PL est ID
M
SA Tape Gur Driver’s
o
e/
Past chool ID able.
S
pt
Valid se is acce
n
Lice
OLSH Parent/Guardian Signature/Consent______________________________________________________
Date__________________________________ Phone Number (_______)____________________________
Permission slips MUST accompany reservation envelope and payment.
Incomplete returns will not be accepted.