Franklin D. Roosevelt High School
Steven M. DeMarco, Principal
5800 20th Avenue * Brooklyn, New York * 11204 * (718) 621-8800
TO BE COMPLETED BY ALL FDR HS STUDENTS ATTENDING THE PROM
WEDNESDAY JUNE 3, 2015
RUSSO’S ON THE BAY 7:30 PM - 12:30 AM
Name (Print) __________________________________
Date: __________________
STUDENT CONTRACT:
1. I will not consume alcoholic beverages or controlled substances before or during the Prom. I understand that
if the school staff suspects that I am under the influence of alcohol or any other controlled substance, I can
be prohibited from attending the Prom.
2. I understand and will abide by the New York City Department of Education’s Discipline Code (“Discipline
Code”).
3. I have reviewed the attached Prom Rules and Regulations and understand them, and I agree to abide by
them. I understand that any deviation from the rules on my part can result in my removal from the Prom and
that I can be subject to additional disciplinary action after the Prom in accordance with the Discipline Code.
Student Signature: _______________________
Date: _________________________
PARENT CONTRACT:
1. I have reviewed the attached Prom rules and regulations with my son/daughter, and my signature below
acknowledges that I have done so.
2. I understand and will remind my son/daughter that once s/he enters the Prom, s/he will not be allowed to
leave the Prom area for any reason, including to retrieve belongings from cars/limousines. Once a
student leaves the Prom s/he may not return. My son/daughter and I understand that post-Prom
limousine arrangements should be made accordingly.
3. I understand that my son/daughter may NOT attend this event unless this permission form/contract is
returned to the class advisor at the time the tickets for the Prom are purchased. I further understand that a
parental signature is required even though the student may be eighteen years of age or older, and that
guests from other schools must obtain a parental signature as well.
4. In the event my child is injured or ill, the staff member(s) in charge of this event may act in my behalf
and at my expense in obtaining medical treatment for my child. I have indicated here any permanent or
temporary medical or other condition(s) which should be known about my child:
__________________________________________________________________________________
______________________________________________________________________________________
5. I give my consent for my child to attend the Prom.
Parent/Guardian Signature: ________________________________________________
Telephone # where parent can be reached on Prom night: ________________________
FDR HIGH SCHOOL PROM RULES AND REGULATIONS
1. Students may invite a guest of their choice. All guests are subject to the approval of the Principal. If the
student guest is not a student at the school, a guest permission slip must be submitted for the student guest
by the student purchasing the ticket no later than one week before the Prom date. The guest permission slip
must be signed by the parent of the guest. Failure to do so will result in the guest being refused admission
to the Prom.
2. The Prom is a function sanctioned by the Department of Education (DOE). All DOE policies relating to
drugs and alcohol will be strictly enforced as per the New York City’s Department of Education’s
Discipline Code. Anyone suspected of being under the influence of drugs and/or alcohol will be prohibited
from attending the Prom. Appropriate disciplinary action will be taken and parents will be notified.
3. This is a non-smoking event. Smoking is prohibited anywhere on the premises.
4. Anyone on suspension on the day of the Prom will not be allowed to attend the event.
5. No refunds will be given if students request to leave the Prom early.
6. No refunds will be given after tickets are purchased unless there are exigent circumstances. Refunds are
subject to the approval of the Principal.
7. The parking lot and cars will be off limits while the Prom is in progress.
8. Proper attire is expected (NO sneakers, shorts, etc.).