Anderson County High School
Out-of-District Prom/Dance Date Request Form
(Currently Enrolled in High School)
Prom/Dance Date Information:
Name:
Date of Birth:
Address:
City:
Phone #:
Drivers License #:
Current High School:
Zip:
Grade:
ACHS Student Bringing Out-of-School Date:
Parent/Guardian (please sign stating you approve this date for your student)
__________________________________________
Signature
Administrator (please sign to affirm that student is in good standing and may attend the ACHS Prom/Dance)
__________________________________________
Signature
ACHS (Office Use Only)
The above student is:
APPROVED _____
DENIED _____
By ACHS Administrator (print name) __________________________________
* ACHS staff/administration reserves the right to run a background check on any out of district dates. In
addition, the decision made by ACHS administration for a date to attend/not attend the ACHS Prom/Dance is
final and may not be appealed.