Thomas WorthingtonHighSchool

300WestDublin-GranvilleRoad

Worthington,OH43085 (School)614-450-6220 (Fax)614-450-6390

PeteScully,Principal Milton Folson,AssistantPrincipal Greg Garris,AssistantPrincipal

Emilie Greenwald,AssistantPrincipal

Jen Goebbel,DirectorofAthletics AdrienneCarr,DeanofStudents ScottGordon,DeanofStudents

DavidQuart,GuidanceDepartmentChair

2017-18 DanceGuestForm

ForthesafetyandsecurityofThomasWorthingtonstudentsandguests,werequirethatourstudentsand theirguests completethisformandreturnit forapprovalbya schooladministratorordeanatleastone(1)daypriortobuyingaticket tothedance.Thiscompletedformmustbe approvedpriortoThomasWorthingtonstudentspurchasinga ticketfortheir guest.

TheTWHSstudentandtheirguestmustfollowtheseguidelinesinordertoenterthedance.

Only1 guestperTWHSstudentispermitted.

Guestsmustbeundertheageof21. (GuestscanNOTbemiddleschoolstudentsoryounger).

GuestsmustarrivewiththeTWHSstudent.

Guestsmustpresenta photoIDthatshowstheirdateofbirth.

Thisformmustbeonfilethenightofthedance.

GuestsmustfollowtheThomasWorthingtonSchoolCodeofConduct.

Iftherearedisciplineproblems/violationsofthe TWHSCodeofConduct,theTWHSstudentandguestwillbe removedfromthedance.

Thereisnore-entrytothedance.

Part1TWHSStudentInformation:(Pleaseprint)

TWHSstudentname:Grade:SignatureofTWHSstudentparent/guardian:

(Parent/guardiansignatureacknowledgesthatyouapproveofyourchildbringinga non-TWHSstudenttothedance.)

Part2GuestInformation(PleasePrint)

GuestName:Grade:Age:Nameofhighschoolifcurrentlyattending*:

Parentname:ParentSignature:(Parent/guardiansignatureacknowledgesthatyouapproveofyourchildattendingthedancewitha TWHSstudent.)

ParentPhonenumber:EmergencyContact:

*Iftheguestiscurrentlyattendinganotherhighschool,pleasecompletethe following:

Part3 AdministrativeInformationfromGuest’sHighSchool:Dearfellowhighschooladministrator:Pleaseverifythat theabovenamedstudentisenrolledinyourhighschoolandisa memberingoodstanding.Pleaseconfirmthefollowing information:

Studentisenrolledinyourschool andtheStudentisa memberingoodstanding .

Administrator’sName: Signature:

Administrator’sContactNumber

Part4TWHSApproval:Administrator

*Please return completed forms to Mrs. Volpe in the Central Office*