Prom Permission Slip MPHS Student



Both you and your date must have a Registration Form signed in order to purchase a prom bid. (This applies to ALL students – even 18 year olds, and out of town guests). Be reminded that by signing, both you and your parents agree to abide by the following:

This year the junior/senior prom will be held on Wednesday, May 25 th at:

The Rockleigh Country Club

26 Paris Avenue

Rockleigh, New Jersey 07647

(201) 786-7171 Emergencies Only

· The cocktail hour will begin at 7:00PM

· Dinner and dance will be from 8:00PM to Midnight

· Those attending must arrive by 7:30. No one will be permitted to enter after this time.

· Allow extra time for traffic; do not plan to leave Midland Park any later than 6:15PM. The approximate travel time is 45 minutes. The Midland Park Alliance sponsored buses will be leaving PROMPTLY at 6:00 PM.

· All limousines should be directed to drop off and pick up at the main entrance. This will be the only way you can enter the venue.

· No one will be permitted to leave the building before 11:30PM once they enter the prom.

At the prom, all Board of Education policies regarding substance abuse and smoking will be in full effect. Any student suspected of being under the influence of /or in possession of any alcohol or illegal substance will be immediately ejected from the Prom and turned over to the Midland Park Police Officer chaperoning the Prom. School rules will be enforced.

Anyone caught smoking on the Rockleigh premises will be asked to leave with their parent(s)/guardian(s).

Pictures - Info and order form will be available when you purchase your prom bid. You will need to bring check or cash the night of the prom.

Early Dismissals from School on May 25 th :

Ø No student will be permitted to leave early if he or she is late to school or does not submit a note signed by a parent or guardian.

Ø All early dismissal notes must be in the office by Monday, May 23rd .

Ø No student will be permitted to leave before 11:30AM.

____________ , _______________

Last Name , First Name


Parent / Guardian Name (s)

Home Phone Number

Parent/Guardian Cell Phone 1

Parent/Guardian Cell Phone 2

Name of Emergency Contact Person

Home Phone Number of Emergency Contact

Cell Phone Number of Emergency Contact

I agree to abide by the Board of Education’s policies stated above.

Student Signature:___________________________ Date: __________

Parent Signature:____________________________ Date: __________

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