Teen Club Information Sheet

Student’s Name:
Address:
Cell Phone (if applicable): / Grade:

Parent/Guardian Information:

Mom: / Dad:
Cell Phone: / Cell Phone:
Email / Email

EMERGENCY CONTACT (if mom or dad cannot be reached):

Name:
Cell Phone: Home Phone:

I will volunteer to work one or more of the following dance(s): Please Circle

September 9th December 16th March 10th May 19th

Please mark your calendar to remind you of your chaperone duties. We really need you to be there when you agree to chaperone.

By signing below, I certify that I have read and agree to follow the rules (see reverse) listed by the Teen Club Committee. I also give permission for my child to participate in Teen Club activities.

Parent Signature:

By signing below, I agree to follow the Teen Club Dance rules and understand that if I do not follow the rules, I will be asked to leave the dance or will not be allowed to attend future dances.

Student Signature:

New Market Middle School

Teen Club

The New Market Middle School Teen Club provides opportunities for New Market Middle School students to interact with their peers during supervised dances held in the school’s cafeteria and gymnasium.

  1. Membership in the Teen Club is mandatory for anyone participating in teen club activities. Membership for all students is $5.00.
  2. The admission price for each event/dance is $1.00.
  3. In order to be a member of Teen Club, the student’s parent must chaperone at least one of the dances. We cannot have the dances without parent chaperones.
  4. Students are expected to follow the same rules, including dress code, as they do at school. Students not dressed appropriately will not be admitted to the next dance.
  5. Dances are held from 7:00pm to 9:00pm. Doors will open to students at 6:50pm
  6. Parents MUST come into the cafeteria to pick up their students at the end of the dance. NO student will be permitted to leave the building without an adult. Please do not take a student out of the cafeteria if you are not responsible for getting the student home. This ensures the safety of the children.
  7. It is imperative that students are picked up promptly at 9:00pm. Students who are not picked up on time or do not follow the school rules may not participate in other dances.

Please fill out the reverse side of this membership application and return it to school as soon as possible. Students can bring this completed form to the dance, but will have to wait with their parent, in the membership line. Students will not be permitted in the dance without a completed membership application. Students may bring money with them to the dance and purchase refreshments.

If you have any questions, please contact Cindy Kneidsen at or (410) 908-8094