Prom Guest Form
Central High School
2017 Prom Code of Conduct Form
113 Central High Road
Carrollton, GA 30116
Phone: 770-834-3386 Fax: 770-832-0103
Central High School students AND guests must submit this form
with payment by March 24, 2017. To ensure that prom is an event
that everyone enjoys, please obey the following rules and
regulations. Read and sign the form.
Prom will be held at Newnan Centre on March 25, 2017 from 7 pm
to 11 pm.
1.Prom is a Carroll County School System event; therefore, all CCSS
policies, procedures, and regulations apply. No student should
possess, use, distribute, sell, possess with intent to distribute
or sell, be under the influence of alcohol, drugs, including
unauthorized prescription drugs, tobacco, and/or any other
controlled substance before, during, or after prom. Such activities
are strictly prohibited by state law as well as school policy and
procedure. Anyone found in violation of this policy may be referred
to the authorities and referred for school discipline.
2. Improper behavior, including indecent dancing, may result in
expulsion from the prom and referral for school disciplinary
3. Students who plan to attend prom must be in good standing at
Central High School, specifically:
~Students who are currently placed at GOAL for disciplinary reasons
may not attend
~Students who are suspended at the time of prom cannot attend
~Students who have been assigned ISS through the Monday after prom
cannot attend prom (to be handled at the discretion of their
4. All fees are non-refundable. See graduated fee schedule.
Juniors and seniors pay prom fees only once.
5. Students are expected to be at school the Friday before prom.
Absences due to preparation for prom are not acceptable.
6. All attendees are required to present a picture ID to the
staff members at the check-in table upon their arrival to the prom.
No student younger than fourteen years of age and a current
freshman may attend. No guests 21 or older will be admitted. The
administration reserves the right to refuse entry to the prom at
7. The CHS student and his/her guest must enter the prom at the
8. Once a student or guest exits the prom, there will be no
re-entry. NO EXCEPTIONS.
9. Prom fees are not transferable. Any student who seeks to
enter the prom must have his name on the prom list. Any student who
is allowed entry without having made previous payment or payment
arrangements will have a hold placed on his records and this fee
will be collected before the student is allowed to participate in
TO BE COMPLETED BY ALL PROM GUESTS:
As a guest of the CHS prom, I agree to obey all rules and
regulations set forth by CHS and the CCSS concerning student
attendance at extracurricular events.
~~I will attend the CHS prom as a guest of _________ (CHS
student), who is a JUNIOR SENIOR. (circle one)
~~I am attending as a CHS JUNIOR SENIOR. (circle one)
Guest (or CHS student) name -- printed _______________ Date of
Guest (or CHS student) signature : __________________ Cell phone
FOR ALL HIGH SCHOOL OR HOME SCHOOLED STUDENTS
Printed parent name : ________________________________
Parent signature: ___________________________________
Parent phone #: ____________________________________
For CHS freshmen or sophomores: I am in grade 9 or 10. (circle
For high school students who attend other high schools:
You must have this section completed and signed by a current
school administrator, and you must attach a copy of your picture ID
(school ID, driver's license, etc.).
Name of high school _______________________ City, state:
I am in grade 9 10 11 12. School phone number:
~To be completed by the guest's high school administrator:
Is the above-mentioned student currently in good standing? YES
Do you recommend this student be permitted to attend our prom? YES
HS Administrator name: ___________________ Title:
HS Administrator signature: ____________________________
FOR GUESTS NO LONGER ENROLLED IN HIGH SCHOOL
You must complete this section and provide a copy of your picture
ID (school ID, driver's license, etc.) Your must show your picture
ID upon entry to prom.
Legal name: __________________________ Date of birth:
Driver's License Number ________________ State: __________