Dance Permission Form for High School Date Not Attending Central Hinds Academy

CHA Student ______Grade ______

Dance: Homecoming 2017 Date: October 6, 2017 Dress Code: Semi-Formal

The Central Hinds Academy student and the student’s date must have this form completed by the appropriate person and faxed from the date’s school to CHA by Wednesday, October 4, no later than 12 noon. This form will not be accepted at the door the night of the dance!!!

Guidelines

Signatures below indicate my/our understanding of and support of the following:

·  Individuals attending C.H.A. dances must be between the ages of 7th grade and age 20.

·  All CHA and MAIS policies, rules, and regulations are in effect at all times. Appropriate disciplinary action will be taken for failure to follow the rules and regulations. Expelled or suspended students may not attend CHA dances.

·  Non-CHA guests entering the dance must present an appropriate picture ID.

·  The CHA student and his/her guest must enter and leave the dance together. The CHA student is responsible for the behavior of his/her guest and is subject to disciplinary action for failure to abide by the rules.

·  Each person must sign his/her dance ticket before entering the dance. This signature acknowledges the understanding and acceptance of information stated on the dance ticket. CHA student and date MUST sign in and out.

·  Parents will be contacted to pick up their child due to misbehavior at the dance.

·  Individuals leaving the building must leave the premises and are not allowed to re-enter.

Please print and sign name where indicated.

CHA student: ______(print) ______(sign)

CHA parent/guardian: ______(print) ______(phone #)

Guest’s name: ______(print) ______(sign)

Guest’s age: ______Guest’s grade: ______

Guest’s school: ______Phone ______

Guest’s parent: ______Phone ______

Principal’s statement: To the best of my knowledge, the student from ______is a student in “good standing” at our school. He/she is not currently suspended and has not been expelled or recommended for expulsion.

Principal’s Signature: ______Phone ______

Please fax to Central Hinds Academy, Att: Stacy Fancher, Ashley Hales or Melissa Powell, 601-857-5082.