UNIVERSITY SCHOOL PROM AND AFTER PROM 2011 Sign-Up ...

UNIVERSITY SCHOOL PROM AND AFTER PROM
2011
Sign-Up Form/Permission Slip for US Student
• Please complete after reading all of the enclosed information carefully.
• Return forms (one from US student and one from date), along with payment, to Mr. Passov by
Friday, April 22, 2011.
Participation Option 1:
_____ My son and his date will be attending both the Prom and After Prom ($240/couple).
Participation Option 2:
_____ My son will be attending the After Prom only ($25/person).
Number of Tickets: ________ (2 MAX)
Payment Method:
_____ Charge US Account _____ Cash _____Check (made payable to: University School)
T-Shirt Size (circle one): S M L XL XXL
Emergency contact information for the evening of Prom and After Prom:
Contact name ______________________________________________________________________
Contact number(s)__________________________________________________________________
We have carefully read the “Important Prom and After Prom Information” document outlining the expectations for the
evening of Prom and After Prom. We have discussed the special responsibility that our son has to abide by the school’s
rules, and he has agreed to do so. He also knows that any violations of these rules will result in severe disciplinary action.
Further, he understands that he must take responsibility for the conduct and well-being of his date, and that all dancing
must be appropriate. Finally, we acknowledge that for the health and safety of our son and his date, they will be
breathalyzed upon arrival at the school for the US Prom (or the After Prom if he attends this event only).
Student Name (Please Print)
Student Signature
____________________________________ Grade _______
___________________________________________________
Parent/Guardian Name (Please Print) ___________________________________________________
Parent/Guardian Signature
___________________________________________________

Questions Please contact Mr. Justin Passov at 216-831-2200 x7429.
Forms may be faxed to 216-292-7808.