ESUMS HIGH SCHOOL 130B LEEDER HILL 06517 PHONE: 203-946-5882

GUEST PERMISSION FORM FOR ATTENDING SCHOOL DANCE COMPLETE BOTH SIDES AND RETURN FORM TO SECRETARY-TERESA FLOWERS Name of ESUMS High School Student (please print):__________________________________ General Information: Forms need to be returned to ESUMS High School no later than March 5, 2014. It is the responsibility of the ESUMS High School student to inform their guest of the dance dress code (on back of this form). It is the responsibility of the ESUMS High School student to return the Guest Permission Form, completed and signed, to ESUMS High School. Each ESUMS High School student and their one guest must sign that they will adhere to the Dance Rules on the back of this form, ESUMS parent and HS Guest’s parent must also sign this form. Guest Information: (Please Print) Name of Guest:___________________________________________________________ Home Phone #:__________________________ PLEASE CHECK ONE: -ALL PARTS OF SECTION 1 MUST BE COMPLETED BEFORE THE FORM IS RETURNED TO ESUMS HIGH SCHOOL. 1. _____GUEST HIGH SCHOOL STUDENT Name of parent:_____________________ Parent Signature:__________________ Name of High School:_____________________________________ Phone # of High School ( ) ______________________________ Guest’s High School Administrator: (Please indicate the status of the above student.) _____ This student is in good standing at our school. _____ This student is not in good standing at our school. Name of Administrator: _________________________Signature:________________ Phone #:_____________________

Guest: (Please read and sign.) I, (print)______________________________agree to respect and abide by the school rules, dance rules (on back), dress code rules (on back), regulations, and policies of ESUMS High School while a guest at the school dance. GUESTS MUST BRING A PICTURE ID TO THE DANCE. SIGNATURE ___________________________________________________________

Dance Rules for ESUMS High School

Name of ESUMS student (print) __________________________________________ Name of Guest (print) ________________________________________________ 1. Once you enter the dance, you must remain in the building until you are ready to leave for the evening. When leaving, you must leave the premises and may not return. No loitering is allowed in the parking lot. School grounds 2. Students must be picked up no later than 15 minutes after the end of the dance. Students may be prohibited from attending future dances if their ride is late. 3. All guests must have a valid picture ID to verify eligibility to attend a dance. 4. Any person suspended or expelled from New Haven School District or any other school district may not attend a dance or any other school function. 5. The dress requirements will be enforced at the door. When in doubt, ask before coming to the dance. 6. Students who dance in an inappropriate manner will be asked to leave the dance and will not receive a refund of the admission fee. Students will not receive a warning before being asked to leave the dance. Parents will be notified if students are asked to leave. There are no refunds. 7. For safety reasons, dancers need to avoid excessive crowding together in the center of the dance floor. 8. Please do not leave valuables unattended. 9. Students are reminded that the New Haven Public Schools Student Code of Conduct applies to all participants at any after school function, including dances. Failure to comply with the rules may result in the potential loss of after-school activities and events. 10. Only one guest may attend with an ESUMS High School student. Please read the above rules and sign below. ESUMS High School student signature:_________________________________ Guest Signature:______________________________________