Prom Out of Town Guest Form

Prom Guest Registration Form

Name of MPHS Student:

Guest Emergency Contact Information:

Name of Guest:

Age: ____________________________

Date of Birth: _____________________

Name of High School:

Home Address:

Guest’s Home Phone #:

Guest’s Cell Phone:

Mother’s Cell Phone:

Father’s Cell Phone:

(NOTE: Guests 21 and older OR younger than a freshman in high school are NOT permitted.)


Notes to Parent and Guest:

· I understand that all Midland Park High School rules apply to me while in attendance at the dance or on school property that evening.

· School officials reserve the right to deny admittance to the dance.

· There are no re-entry privileges at the dance.

· All students attending this dance are reminded to also adhere to the Midland Park School Board of Education Substance Abuse Policy. Any student suspected to be under the influence of and/or in possession of illegal substances the night of the dance, will be immediately ejected from the dance and turned over to the Midland Park Police Officer chaperoning the dance. School rules will be enforced.

· Absolutely no smoking is permitted on the premises.

· Guests will be required to present a photo I.D for admittance.

· All students attending the dance are reminded to adhere to the school dress code when planning for the evening. If a dress or outfit is deemed inappropriate by any of the staff chaperones, you will be asked to change or leave the dance for the evening with no refund. Please plan accordingly!

Guest Signature:

Parent Signature:

(Any student currently enrolled in high school needs a signature from a parent)

Guest School Administrator: Please sign this form if the above named student is enrolled at your school and in good standing both socially and academically.

Administrator Signature: Date:

Administrator Name: Phone #:

Midland Park Student’s Parent Approval

I am aware of, and approve of, my son/daughter bringing this guest to the MPHS dance.

Parent Signature:

Parent Name:

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