Fairfield Area High School - Guest Pass
4840 Fairfield Road, Fairfield PA 17320 - Phone: 717-642-2004 Fax: 717-642-2029
Students who wish to invite a guest to attend a school dance must have pre-approval from the
administration. A guest is defined as a non-FASD student. This guest pass is necessary and must be
completed in its entirety to receive that approval. Middle school students are not permitted to attend.
Only students in grades 9-12 and guests under the age of 21.
COMPLETED guest passes must be turned into the office no later than Thursday, April 16, 2015
ALL SECTIONS OF THIS FORM MUST BE COMPLETED IN ITS ENTIRETY PRIOR TO TURNING IT
INTO THE HIGH SCHOOL OFFICE - NO EXCEPTIONS!!!!!!!!!!!!!!!!!!!!!!
__________________________, Grade _____, has requested _______________________________
Host (Fairfield Student)
Guest (print name)
To attend Fairfield High School 2015 Prom: “The Great Gabsy”
Where/When/Time: Friday, May 1, 2015, 6-10 PM, At the Outpine Liberty Mountain
Section I:
Students’ Statement:
I understand the responsibilities and expectations when attending school-sponsored events and agree to
follow those expectations in order to contribute to a positive experience for all. These expectations include,
but are not limited to, appropriate dress, no possession and/or use of alcohol or tobacco, and no illegal drugs.
Non-Fairfield guests must bring a photo ID with them to the event.
Fairfield Student’s Name: ________________________
Signature: _________________________
Guest’s Name: _______________________
Signature: _________________________
Section II:
Age _____
Guest Parent/Guardian’s Statement:
I give permission for my son/daughter to attend the above stated function of Fairfield Area High School. I am
aware of the responsibilities and expectations for participation in such an event and support Fairfield Area
School District’s efforts to secure and maintain a safe and enjoyable experience.
________________________________
Parent/Guardian
______________________________ _____________________
Signature
Phone
Section III: Home School Reference for Non-FASD Students –Completed by Home School
Administration
The above individual has requested permission to attend a function of Fairfield Area School District. Please
verify that he/she is a student in good standing and would contribute to a positive experience at this event.
You may call the high school office at 717-642-2004 to further discuss the matter, if necessary. This form can
be faxed to FASD 717-642-2029 Attn: High School Office.
The above student is currently enrolled at _____________________________________ (name of school)
and has demonstrated (please check which pertains below)
_____ Acceptable behavior that should qualify him/her to attend this event.
_____ Unacceptable behavior that should disqualify him/her from attending this event.
______________________________________
Administrator’s Signature
_____________________
Phone #
_________________
Date
** Students not currently enrolled in school but within the specified age limits must call Fairfield Area High
School to seek attendance approval. Calls must be placed within five days of the event**
(Only students under the age of 21 will be permitted.)