Riverside High School
19019 Upper Belmont Place
Leesburg, VA 20176
Ph.: (703) 554-8900
Fax: (703)858-7910
High School Dance Guidelines and Permission Form
Please review the following rules and regulations:
1. All school rules apply for dances held both on and off school property.
2. Those attending dances are expected to wear appropriate attire.
3. Inappropriate dancing including “twerking” and “grinding” will not be allowed.
INITIAL HERE: __________________
4. There will be no entrance into the dance after 9:00 pm.
5. Once you leave the dance, you may not re-enter.
6. Ticket costs may not be refunded, even if you are asked to leave.
7. Guests must provide a valid photo ID, may be subject to administrative approval, and
must follow all LCPS rules and regulations.
8. School administration reserves the right to deny entrance to the dance and/or ask any
dance participant to leave.
***********************************************************
I have read and understand these rules and regulations, and agree to abide by them.
I also understand that I am responsible for the actions of my guest(s).
* I am bringing a NON-RIVERSIDE guest: Please check the box that applies.
 Yes – Name of guest ____________________________________________
 No
___________________________
Print Student Name
______________________________
Print Parent/Guardian Name
__________
Grade
___________________________
Student Signature
__________________________________________________
Parent/Guardian Signature
I have reviewed these rules and regulations with my son/daughter. A phone number at which
I can contacted at is ___________________________________________.
* If you are bringing a guest that DOES NOT ATTEND RVHS, please fill out the guest form and
bring both permission papers with you when purchasing your tickets.
Riverside High School
19019 Upper Belmont Place
Leesburg, VA 20176
Ph.: (703) 554-8900
Fax: (703)858-7910