Luella High School
Prom 2015
Saturday, April 25
The Great Gatsby –
Glitz and Glamour
200 Peachtree – Atlanta, GA
(200 Peachtree ST, downtown Atlanta)
8:00 PM – 11:00 PM
PROM APPLICATION
Must be completed by any Luella Student attending Prom, prior to purchasing ticket(s).
Student Name:_____________________________________________________________
Student Number: ______________ Class:
Senior Junior Sophomore Freshman
Student e-mail address: __________________________________________________
Prom 2015 is a school event; therefore, all Henry County Schools and Luella High School rules and regulations
apply. Those may be found in the 2014-15 Student/Parent Handbook.
Inappropriate behavior at Prom 2015 will result in the student being removed from the Prom and appropriate,
additional consequences assigned later. Parents will be contacted where necessary.
Since this is a night of Glitz and Glamour, the LHS Dress Code will provide a guideline for appropriate dress.
 The expectation for all attendees is that she/he is dressed appropriately for a formal occasion and is not
immodest in her/his appearance.
 Mr. Smith, LHS principal, does reserve the right to not allow students into to or to remain at Prom
2015, if the individual is dressed inappropriately.
If an individual is not admitted or is asked to leave Prom 2015, no refunds will be given.
Expectations Understanding:
By signing below, I affirm that I have read this form and am aware of the expectations for Luella High School
students at Prom 2015, as well as being aware that appropriate consequences will be assigned if I do not adhere
to the expectations.
LHS Student signature: _______________________________________________
Parent Agreement:
I give my permission for my Luella High School student to attend Prom 2015 and understand that all LHS rules
and regulations apply, other than the one stated above.
Parent Signature: _____________________________________________________
Date:_________________________
Luella High School
Prom 2015
Saturday, April 25
The Great Gatsby –
Glitz and Glamour
200 Peachtree – Atlanta, GA
(200 Peachtree ST, downtown Atlanta)
8:00 PM – 11:00 PM
NON – LHS Student Assurance Form
Must be completed by any non-Luella Student attending Prom, prior to purchasing ticket(s).
Student Name:_____________________________________________________________
Age: ______________ School Attended: ___________________________________
Student e-mail address: _________________________________________________
The Luella High School Prom 2015 is a school event; therefore, all Henry County Schools and Luella High
School rules and regulations apply. Those may be found in the 2014-15 Student/Parent Handbook. By
attending this LHS school event, you are bound by the rules and regulations of the Henry
County Schools and Luella High School. Inappropriate behavior at Prom 2015 will result in your being
removed from the Prom and appropriate, additional consequences may be imposed if the matter is turned over
the Atlanta Police or the Henry County Sheriff’s Department (SRO). Parents will be contacted where necessary.
Since this is a night of Glitz and Glamour, the LHS Dress Code will provide a guideline for appropriate dress.
 The expectation for all attendees is that she/he is dressed appropriately for a formal occasion and is not
immodest in her/his appearance.
 Mr. Smith, LHS principal, does reserve the right to not allow students into to or to remain at Prom
2015, if the individual is dressed inappropriately.
If an individual is not admitted or is asked to leave Prom 2015, no refunds will be given.
Expectations Understanding:
By signing below, I affirm that I have read this form and am aware of the expectations for Luella High School
and realize that those expectations apply to me. I am also aware that appropriate consequences will be assigned
if I do not adhere to the expectations.
NON Luella High School Student signature: _____________________________________
Parent Agreement:
I give my permission for my daughter/son to attend Prom 2015 and understand that all LHS rules and
regulations apply and that appropriate consequences will be assigned if she/he does not adhere to the
expectations.
.
Parent Signature: _____________________________________________________
Date:_________________________