Visitor Permission Form for Prom
Please complete sections A, B, and C, sign and submit to Shannae Jackson (Assistant Principal) in the
Office 106. The form must be completed and submitted to Ms. Jackson BEFORE a ticket may be
purchased. Guests of Brooks students must be enrolled in a high school or must be at least 15 years and
less than 21 years of age. Please note that sections B and C require parent/administrator signatures to be
considered valid.
Event: _____________________Date of Event: _______________________
Section A
Brook’s Student Name: _______________________________________
Student’s Grade: ________________
Section B
Name of Guest: _______________________________________________
Guest’s Age: __________ Guest’s Phone Number:_____________________
Guest’s Address:_______________________________________________________
Guest’s State ID/Driver’s License/School ID Number: __________________________
Guest’s Guardian or Emergency Contact Name: _______________________________________
Emergency Contact Address and Number: ____________________________________
To be filled out by an administrator at the visitor’s school:
Is this student in good standing?____________________________________________
Name of School/University:
________________________________________________________
Printed Name of School Administrator:
_______________________________________
Signature of School Administrator:
__________________________________________
Section C
I understand that the above guest will be attending Prom with my son/daughter. All
rules set by Brooks College Prep High School and the Chicago Public School District
apply during the event. If there is a violation of these rules and/or regulations, the
above will be asked to leave the grounds, may be referred to the authorities, may be
subject to school/district discipline consequences, and I, will be contacted immediately.
Parent Signature:______________________________Phone:__________________
(Parent of Brooks Student)
Gwendolyn Brooks College Prep
Fax Number: 773-535-9939
GUESTS MUST BRING IDENTIFICATION (PICTURE ID) TO THE PROM.