Shenendehowa High School Dance

GUEST INFORMATION APPLICATION

***This form must be filled out and signed before you purchase a ticket for your guest.

Dance ___________________________  Date ________________

Shenendehowa High School Student:

Name______________________________   Grade_________

Contact Number____________________       Contact Name/Relationship                              

Parent/Guardian Signature_______________________________

Guest Information: Permission is hereby granted for Shenendehowa High School to receive information regarding:

Guest’s Name______________________________  Guest Age _______     Grade__________

Address_______________________________________________

______________________________________________________

Parent/Guardian’s Name_____________________________

Phone number where parent/guardian can be reached during the dance:                                                            

High School Currently Attending________________________________

Guest Parent/Guardian Signature________________________________

To be completed by High School Administrator of Guest:

The “guest” listed above has been invited to a Shenendehowa School function.  The “guest” must be eligible to participate in extracurricular and school functions at his/her home district to be eligible to be a guest at a Shenendehowa School function.

Is this student eligible to participate in extracurricular and school functions at his/her Home District?

             Yes               No

High School Administrator Name/Title________________________________________

High School Administrator Signature________________________________________

High School Administrator Contact Number ________________

Shenendehowa Administrator Signature __________________________