Application for 2004 Prom Guest Pass

Guest Pass Application: Non-MHS Students for MHS PROM
Turn into Associate Principal’s Office by April 15th 2015
Students bringing non-MHS guests to the Mukwonago High School Prom must abide by the following regulations:





Submit this completed form to receive permission to buy a guest’s prom ticket WITH copy of photo ID (attach)
(this application & copy of photo ID may also be faxed to: 262-363-6239)
Student must enter and leave the dance with their guest
Guest must show driver’s license and/or photo identification for admission
MHS students are responsible for informing their guest of all MHS behavior and dress code rules.
Each pass is verified for accuracy. Any falsification of information and/or signatures will result in denial of Prom
attendance and forfeiture of any fees paid by MHS student and guest. MHS students may receive additional disciplinary
action.
GUEST INFORMATION (please print)
Name: ____________________________________________ Age _______ (must be less than 21 per attached ID)
Address: __________________________________________Parent/Guardian Name: ______________________________
Parent Contact Number_______________________________Parent/Guardian Signature: ___________________________
(signature needed if student is in high school)
(parent and guest have read MHS Prom Policies)
Any food allergies?
Yes / No
T-Shirt size: XS S M L XL XXL XXXL
Emergency Contact Name__________________________________
Emergency Contact Number________________________________
Please select one:
 Guest will be attending Prom & Post Prom ($90)
 Guest will be attending only Prom ($90)
 Guest will be attending only Post-Prom ($15)
High School Name: ______________________________________
If you are a student at another high school, you need the signature from your school principal (unless you are a college
student), and a school seal/stamp to verify the legitimacy of this signature. By signing below the school official substantiates
that you are a student in good standing at the school listed above.
Principal Signature_______________________________
MHS STUDENT INFORMATION (please print)
I am responsible for my guest at Prom. My guest and I will abide by all of the MHS rules and regulations.
Name: __________________________________________MHS Student’s signature: ________________________
MHS STUDENT’S PARENT
“I understand that my son/daughter will be taking a non-MHS guest to the Prom and that a guest’s poor behavior can result in
consequences for my child.” Parent’s Signature________________________________________Date______________
MHS ADMINISTRATION
MHS Administrator’s Signature_________________________________ Date ___________________
A Copy of the Guest’s PHOTO ID or Driver’s License Must Be Attached
The AP Office will return this form to Mrs. Wierzbicki or Mrs. Iverson so that you may purchase your guest’s ticket.
Only this form will be accepted. NO SUBSTITUTIONS!