Greeneview High School
4710 Cottonville Road
Jamestown, Ohio 45335
phone: (937-675-9711) fax: (937-675-6805)

click here to download form in .pdf format

GHS DANCE GUEST APPLICATION
(Submitted 48 hours prior to the dance)   (Limit one guest per Greeneview HS student)
(Guest must be enrolled in high school or older: i.e. no Middle School students)

Name of Dance: (Homecoming, Prom, etc.)   ________________________________________________________

Date of Dance: ________________________

This application to bring a non-Greeneview High School student to the dance must be submitted to Greeneview High School administration for approval.  The Greeneview High School Code of Conduct is in effect at this function for both you and your guest.

PART 1: Greeneview High School Student Responsibilities Statement
(To be signed by the Greeneview Student)

I understand that my non-Greeneview guest and I are both subject to the Greeneview High School Code of Conduct while attending this event.  I understand that failure to comply with Greeneview High School rules and expectations may result in my and/or my escort’s immediate dismissal from the event with no refund of admission monies.  I will be sure that my guest understands Greeneview High School rules and expectations.

Greeneview High School Student Name (print name): __________________________________ Grade: _______

IMPORTANT: Greeneview High School Student Signature:  __________________________________________

Parent Signature ____________________________________________   Phone:  _________________________

PART 2: Guest Responsibilities Statement    (To be signed by guest)

I understand that my Greeneview High School escort and I are to abide by the rules and expectations of the Greeneview High School Code of Conduct while attending this event.  I will be sure to clarify those rules and expectations with my Greeneview escort, especially those regarding no possession or use of drugs, alcohol, tobacco, and also those about being respectful, not fighting, not using profanity, refraining from inappropriate displays of affection and any dancing which mimics sexual acts or is sexually explicit.  Failure to comply with Greeneview High School rules and expectations may result in my and/or my escort’s immediate dismissal from the event with no refund of admission monies.

Guest’s Name (print name):  _____________________________________ Grade ___________ Age ___________

IMPORTANT: Guest’s Signature:  ________________________________________________________________

Emergency Contact: ___________________________________ Emergency Phone: ________________________

PART 3: Adult Reference    (To be signed by Guest’s Principal)

By affixing my signature, I hereby attest that the person applying for guest approval has maintained acceptable standards of behavior to date and is either:

1. Enrolled in the _______________________________________________ School District,
2. Is attending _______________________________________________University, College or Technical School.

IMPORTANT: Signature of school principal or school administrator: ___________________________________
Phone number of school principal or school administrator: ___________________________________

__________________________________________