Junior Prom 2010:
Information Packet
“Enchanted Amazon”
May 14th, 2010
7 – 11pm
Instructions:
·
Prom bids cost $65 per person, therefore $130
per couple.
·
Payment must be in full at time of purchase. Cash
or check only.
Ø
Make checks out to
·
Prom bids will be sold AFTER SCHOOL ONLY
in room 2401 on April 21st – May 5th!
Please make a note of these dates!
·
Your contract must be completely filled out in
order to purchase your prom bid.
·
Tables will be chosen the day you buy your bid.
Ø
If you know who you would like to sit with, they
must come with you and buy their bid at the same time.
Ø
You will not be able to fill in your name at a
table if you have not purchased a bid.
· You must select one of the
following meal choices:
·
Chicken Francaise
·
Prime Rib
·
Penne a la Vodka
Junior Prom 2010
Please make sure all boxes are completely
filled out!
Student # 1:
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Student Name |
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Student Cell Phone: |
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Parent/Guardian Name: |
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Parent/Guardian
Contact Number(s): |
Home: Cell: |
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Emergency Contact Name
& Phone Number: (Used in the event the
Parent/Guardian cannot be reached.) |
Name: Phone Number: |
Student # 2/Guest:
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Student Name |
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Student Cell Phone: |
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Parent/Guardian Name: |
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Parent/Guardian
Contact Number(s): |
Home: Cell: |
|
Emergency Contact Name
& Phone Number: (Used in the event the
Parent/Guardian cannot be reached.) |
Name: Phone Number: |
Meal Choice:
|
Student #1 |
Student #2 |
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Dear parents/guardians:
Please carefully review the 2010 Prom
Contract below, as the terms and conditions will apply to all Middletown Junior
and Senior Proms. The 2010 Prom Contract will govern the behavior of
Sincerely,
Patricia Vari-Cartier
Principal
Prom
Contract
Initials: Student #1
_____ Parent #1 _____ Student #2 _____ Parent #2 ______
Prom
Contract
Substance Abuse
Policies and Procedures for Proms
The following procedures
will be carried out for any student or guest suspected of possession or use of
alcohol or a controlled dangerous substance.
1.
The student or
guest will be required to submit to a urine test and/or a breathalyzer test
that may, at the discretion of administration, be administered on site at the prom,
at the local police station, or at a medical facility.
2.
A
parent/guardian will be notified, and the parent/guardian will be required to
pick up his/her child. No refund of the
prom bid will be given.
3.
The police
will be notified. The student/guest may
be subject to police action, including arrest or other legal charges.
4.
All
consequences outlined in the Student Handbook and Board Policy will be
enforced, including suspension, loss of parking privileges, loss of privileges
to participate in extra-curricular activities and sports, and any other
applicable penalties.
5.
A CONFIRMED POSITIVE DRUG/ALCOHOL TEST OR CONFIRMED
POSSESSION OF ALCOHOL, DRUGS, OR DRUG PARAPHERNALIA WILL RESULT IN LOSS OF THE
PRIVILEGE FOR SENIORS TO PARTICIPATE IN THE GRADUATION CEREMONY.
Students and their guests
are expected to act in a mature and appropriate manner at the prom. The prom facility is considered an extension
of the school; therefore, all school rules and Board Policies, including disciplinary
actions, will be in effect. The
parent/guardian will be notified if a student disregards the rules and
policies, and the student/guest may be removed from the prom with no refund of
the prom bid.
Any student bringing an
escort who is not a student of Middletown Public Schools will be responsible
for his/her escort adhering to this contract as well as all school rules and
Board policies.
Any student found
falsifying any information, signature, or initials on this contract will not be
permitted to attend the prom, no refund will be given, and disciplinary action
will be taken.
Compliance with the rules
set forth in this contract as well as school rules and Board Policies is a
condition of admittance to and continued attendance at the prom. Violations of this contract, school rules, or
Board Policies will result in disciplinary action, removal from the prom, and
parent/guardian notification. Violation
of the Board’s Substance Abuse Policy will also result in police notification
and loss of certain privileges, including loss by senior students of the
privilege to participate in this year’s graduation ceremony.
Prom bids are
nonrefundable.
Administrative discretion will be used in the final adjudication of
all penalties and disciplinary actions.
Initials:
Student #1 _______ Parent #1 _____
Student #2 _______ Parent #2
______
The undersigned acknowledges reading and understanding the
rules and requirements appearing on the previous two pages of this Contract,
and agrees to abide by them as a condition of attendance at the Middletown High
School North/South prom.
Further, I promise not to drink alcohol or consume any
illegal substance on prom night. I
commit myself to celebrating in a safe and healthy way. I pledge not to get into a car with someone
who has been drinking alcohol or who has consumed an illegal substance. If I find myself in a situation where I feel
unsafe or uncomfortable, I promise to call you, my parent or guardian, for a
ride home. I commit to this pledge and
recognize there are consequences for every decision I make. In signing this contract, I fully understand
and acknowledge the conditions of attendance at the prom, and will adhere to
the aforementioned conditions and advise my date of the same.
Student #1 Name
_____________ Student #1 Signature
_______________ Grade ____
Student #2 Name _____________ Student #2 Signature _______________ Grade
____
□ My escort is NOT from MHSN/S.
Fill in information below.
Name of Guest NOT from MHSN/_____________________________________
Signature of Guest NOT from MHSN/S ___________________________________
Age of Guest _________ School Attending_____________________________
Signature of School Administrator
at guest’s school attesting to student’s good standing at the school and
permission to attend
Administrator Name and Title _________________ Signature ___________________
The undersigned acknowledges reading and understanding the
rules and requirements appearing on the previous two pages of this Contract,
and agrees to abide by them as a condition of attendance at the Middletown High
School North/South prom.
Further, as a parent/guardian of a student attending the
Parent
Information—Student #1
Parent/GuardianName
______________ Parent/Guardian
Signature________________
Home Phone Number _______________ Cell Phone Number ___________________
Emergency Contact Name
________________ Telephone Number __________________
Parent
Information—Student #2 or Guest
Parent/Guardian Name
______________ Parent/Guardian
Signature_______________
Home Phone
Number ________________ Cell Phone Number ___________________
Emergency Contact Name
_____________ Telephone Number
___________________