BEREA-MIDPARK HIGH SCHOOL

BMHS STUDENT AND GUEST DANCE FORM

EVENT: Homecoming DATE: Saturday, September 30, 2017

This form MUST be completed and returned beforepurchasing a ticket to the dance by anyone bringing a person not currently enrolled at BMHS.

  • The dance will be held from 6:00 P.M.to 10:00 P.M.
  • All Berea-Midpark High School Code of Conduct Rules and Regulations will be in effect during the dance. Guests are expected to comply with these rules and regulations as well.
  • NO 8th grade students or younger will be admitted as dance guests.
  • NO guest over the age of 20 is allowed.
  • Guests must present a photo I.D. to enter the dance.
  • Once students leave the dance, they may not return.

PART I: TO BE COMPLETED BY BMHS STUDENT.

Name Printed: Signature: ______

ID # ______2ndPeriod Teacher/Classroom: __Home Phone Number:

I understand that I may not attend this dance if I am on disciplinary probation. I understand that my guest and I are subject to all rules and regulations of Berea-Midpark High School and failure to abide by these rules may result in removal from the dance and/or disciplinary action.

PART II: TO BE COMPLETED BY GUEST and GUEST’S PARENT/GUARDIAN.

Name: School Attending:

Home Address: Home Phone:

Parent Cell Phone: ______

Guest Signature:

My signature indicates my agreement to follow all rules and regulations of Berea-MidparkHigh School. Failure to abide by these rules may result in removal from the dance and/or disciplinary actions. To assist Berea-Midpark High School in determining whether I am in “good standing” with my high school, so that I may attend the above named event, I hereby consent to the release of personally identifiable information and/or educational records from my high school to Berea-Midpark High School. If currently enrolled in high school, an administrator must complete thesection below.

Guest Parent Signature (ALL GUESTS):

As the parent/guardian of the above named guest, I hereby consent to the release of personally identifiable information and/or educational records from my son/daughter’s high school to Berea-Midpark High School to verify whether or not they are in “good standing” with the above named high school.

The above named guest is enrolled and I hereby consent to this high school exchanging personally identifiable information and/or educational records with Berea-Midpark High School to verify whether or not I am in “good standing”. If not enrolled in high school, then leave blank.

Signature of Guest’s AdministratorSchool Date

PART III: TO BE COMPLETED BY PARENT/GUARDIAN OF BMHS STUDENT.

I,______, am aware that my student will be attending this dance with the guest named above. I understand that I will be contacted if any concerns arise. I also understand, if necessary, the police may be called.

_____

Parent/Guardian Signature of BMHS Student