Thomas Jefferson High School for Science and Technology
FAIRFAX COUNTY PUBLIC SCHOOLS
6560 Braddock Road
Alexandria, VA 22312
Phone (703) 750-8300
Guest Application for TJHSST Homecoming Dance: Saturday, September 27, 2014
This form must be filled out in the order the information is requested. The guest’s principal WILL NOT SIGN unless his/her
parent/guardian has signed off first.
NOTE: All Guests Must Bring A Photo ID To The Event.
Event: Homecoming Dance, September 27, 2014 at Thomas Jefferson High School for Science and Technology Main Gym, 8-11:00pm
TJ Student Host Information:
Name: _________________________________________________________________
Address: ____________________________________________________________________________________________________ Phone: ____________________
Parent/Guardian Name: ________________________________________________________
As a student of TJHSST, I understand that I may bring only one guest and that guest may not be below high school age. Additionally, I understand that my guest and I
will be held accountable and responsible for complying with the code of conduct as set forth by Fairfax County Public Schools.
Signature of TJ Student Host __________________________________________________________
Guest Information:
Name: __________________________________________________________________
Address: ____________________________________________________________________________________________________ Phone: ____________________
Parent/Guardian Name: _________________________________________________________
I understand that my TJ host and I will be held accountable and responsible for complying with the code of conduct as set forth by Fairfax County Public Schools. I
understand that once I leave the dance for any reason, I will not be readmitted.
Guest Signature ___________________________________________________________
Guest Parent/Guardian:
I understand that my son/daughter is attending the Thomas Jefferson High School Homecoming Dance on September 27, 2014. I acknowledge that the dance ends at
11:00pm and it is ultimately my responsibility to make sure that my son/daughter is transported from TJHSST at that time.
Guest Parent/Guardian Signature ____________________________________________________
To be filled out by the guest’s Principal:
______
I recommend this student to be approved as a guest at the function listed above. S/he is a student in good standing.
______
I recommend this student NOT be approved as a guest at the function above because S/he has been involved in disciplinary actions and/or is not a student in
good standing.
Principal’s Name: _________________________________________
Principal Signature ___________________________________________
Note: If you are not a high school student, please provide your university or place of employment in the space above. No administrative signature is needed, but
complete all of the above contact information and sign.
This form is due to the TJHSST Main Office or it may be scanned and emailed to sga.tjhsst@gmail.com
FORM DUE BY 4 PM ON WEDNESDAY, September 24, 2014 (no exceptions!)
On Thursday, September 25th a list of all approved guests will be posted outside the Activities Office in the Audlob.
If your guest’s name is not on the list, they may NOT attend the dance.