Edward L. Yergalonis
Superintendent of Schools eyergalonis@rahway.net
“ Expecting Excellence”
Kline Place
P.O. Box 1024
Rahway, NJ 07065
(732) 396-1000
Non-RHS Student Application
Rahway High School Prom
The Hanover
16 Eagle Rock Avenue East Hanover, NJ 07936
973-887-2682
6:30 PM –11:00 PM, June 12, 2015
ATTENTION: This form must be signed by the visitor’s administrator and faxed to RHS @ 732-396-2630.
Name of RHS Student: ________________________________________________________________
( Note: All prom attendees are responsible to follow all rules set forth by the prom advisors, administration, and the Rahway Board of Education File Code: 6145, 5114, and 5131.)
Non-Rahway High School Student Information:
Name: _____________________________ Grade: __________ DOB: _________ Age:_______
Address: __________________________________ City: _______________________________
Parent/Guardian Name: ____________________________ Cell # _________________________
2 nd
Emergency Contact Name: ______________________ Cell # _________________________
A.
Name of high school currently attending : _____________________________________________
To administration of high school listed above: Is this student eligible to go to his or her own prom?
YES or NO ( circle ). If NO please give a reason.
_______________________________________________________________________________
Name/Title of Administrator: _____________________________________________________
Signature of Administrator: _______________________________ Date: _________________
B.
If college student, name of college currently attending : __________________________________
Address of College: ____________________________________ Graduation Year: _________
C.
Acceptable forms of ID: Valid Driver’s License
High School ID College ID
Valid State Non-Driver’s ID
Passport ID Card
Identification submitted ( attach copy ): _______________________________________________
D.
If guest is not currently enrolled in school, please supply work information:
Name/Address of Employer: _______________________________________________________
Name/Phone number of Supervisor: _________________________________________________
As the prospective guest of _______________________________________, I agree to follow all guidelines set forth by the prom advisors and the Rahway Board of Education. I also understand that I may be removed from the prom, without a refund, if I violate any of the rules and regulations related to
Rahway Board of Education File Code: 6145, 5114, and 5131.
_______________________________
Name (Printed)
___________________________________________
Signature Date