COLUMBIA CITY HIGH SCHOOL PROM
1. ADMITTANCE ONLY TO THE FOLLOWING:
a. Columbia City High School students
b. A guest of a CCHS student if the following are true:
 The guest is a junior or senior in high school standing
o No sophomores from any school at CCHS prom
 The guest has been registered and approved by the
administration if not in high school
 The guest is at least 16 years of age and less than 21 years of age
2. Guest registrations may be found on the CCHS website.
a. Only one guest per student may be registered.
b. All guest registrations must be submitted to the main entrance
receptionist by 3:20 p.m. on April 19.
c. The Columbia City student is responsible for his or her guest’s
behavior.
d. The guest must enter the dance with the student who registered that
student and obtained the guest pass for him or her.
e. The guest must present current photo identification with ticket.
3. Anyone who leaves the building during the dance will NOT be permitted
to re-enter.
4. Alcohol, tobacco, or other drugs are absolutely NOT permitted on school
property or at school functions.
5. No tickets will be sold at the door they must be pre-purchased prior to
3:20 p. m. on April 26, 2013.
6. A CCHS representative will contact the CCHS student if the student’s
guest is not approved by April 25, 2013.
7. Prom ticket refunds are not available for guest refusal.
Columbia City High School
600 N Whitley St., Columbia City, IN 46725
260-244-6136; fax: 260-244-7326
Guest Registration Form
______________________________ ____
________________________________
Name of CCHS Student (print)
Grade
_________________________________________
Signature of CCHS Student
______________________________________
Date
As the parent/guardian of the above CCHS student, I approve of
his/her guest for the dance.
__________________________________
________________________________
Name of CCHS Parent (print)
Phone number
_____________________________________________
Signature of CCHS parent
____________________________________________
Date
Guest Information - Please make sure information is legible, or guest may be denied.
__________________________________
____________________________________
Name of Guest (print)
Signature of Guest
________________________
Current Age
____________________________
Date of Birth
________________________________________
Home Address
____________________________________
Phone number
_______________________________________ _____________________
City
State
___________________________________________________
Name of School/Employer
Is the guest a CCHS graduate? Yes or No
Is the guest a former CCHS student? Yes or No
(over)
________________________________________________
School/Employer Phone Number
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A guest is defined as any person not currently enrolled in CCHS.
Guest must abide by all school rules. The student bringing his or her guest must make these rules clear to
the guest.
All guests must have this form completed, and returned to the main door receptionist.
All guests must be registered by FRIDAY, April 19th, 2013. NO EXCEPTIONS!
No outside guests will be admitted at the door without being registered.
No student or guest will be admitted at the door without a ticket and a school ID/photo ID.
All guests must be juniors or seniors or have prior approval. (No middle school, 9th grade, or 10th grade
students admitted to prom. No individuals over twenty years old admitted to prom.)
As the Principal/Administrator of the school the named guest
attends or employer, I verify he/she is a student/employee in
good standing.
__________________________________
____________________ ____________________
Print the Name of the School Administrator/Employer
Title
__________________________________________________
Signature of School Administrator/Employer
Phone Number
________________________________________________
Date:
Comments: ____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
CCHS Office Use Only:
Columbia City High School reserves the right not to allow any student or guest to participate in an afterschool extra-curricular activity.
Guest Approved by CCHS? _______yes _______no
Comments: _________________________________________________________
__________________________________________________________________
Saved G:Staff/Guest Registration Form and Instructions