Greensburg Salem High School
2015 Prom Ticket Order Form
“Casino Royal”
Please complete all relevant information on this form. This completed form along with the “CONTRACT
FOR NON-GREENSBURG SALEM STUDENTS” (if applicable) and payment in the amount of
$150/couple or $75/ per single should be placed in the attached envelope and turned in to Mrs.
O’Neill in room 373 throughout the day OR to her in the main lobby between 7 a.m. and 7:30 a.m.
Applications will be accepted through Wednesday, April 15th, 2015. No applications will be accepted after 3:00
p.m. on Wednesday, April 15th. Cash or checks will be accepted. Make checks payable to GREENSBURG
SALEM ACTIVITY FUND-Formal Dance.
SCA is offering a layaway-style purchase. Tickets may be purchased with a $25 down payment per ticket
to Mrs. O’Neill and the rest may be paid in small increments until the tickets are paid off. Tickets must be paid
in full by April 15th.
Grand March lineup will be determined by order in which applications are received with the exception of class
officers, SCA and prom committee officers and chairmen. Those who are purchasing their tickets on the
layaway plan will not be added to the Grand March lineup until their tickets are PAID IN FULL.
Please be sure to PRINT your name and the name of your date (the way you want it to appear in
the Grand March program) on the envelope. Tickets will be issued to the first student listed on the
application, through your first block teacher.
Only one order should be placed per couple. If incomplete orders are submitted, they will be returned to the
submitting student and will be renumbered when they are complete.
____________________________________
PREASE PRINT LEGIBLY, detach and place in envelope
NAME: __________________________________________________
BLOCK 1 ROOM #_____ BLOCK 1 TEACHER’S NAME_____________
GRADE: __________
HOME PHONE: ______________________
NAME OF PARENT/GUARDIAN _____________________________
DATE’S NAME: _____________________________
GSHS STUDENT? YES / NO
If Yes, BLOCK 1 ROOM#____
BLOCK 1 TEACHERS NAME__________________ GRADE: ________
If No, SCHOOL GUEST ATTENDS: ____________________________
HOME PHONE: ___________________________
NAME OF PARENT/ GUARDIAN: ______________________________
IF GUEST IS NOT A GSHS STUDENT THEN PLEASE
COMPLETE THE NEXT PAGE AND SUBMITT IT ALONG WITH THIS
FORM AND A PHOTO ID.
Please write down the title and artist of a song you would like to be played at Prom:
Artist:_______________________ Song title:________________________
RULES AND REGULATIONS
FOR THE 2015
JUNIOR/SENIOR PROM
“Casino Royal”
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Admission is limited to Greensburg Salem seniors, juniors, and guests. Guests are not limited to
Greensburg Salem students. Guests may be any current high school student or a high school
graduate (must submit proof of graduation) under the age of 21 as of May 8th, 2015. JUNIOR
HIGH OR MIDDLE SCHOOL STUDENTS ARE NOT PERMITTED TO ATTEND THE PROM. All school districts
and grade levels will be verified. NO EXCEPTIONS WILL BE PERMITTED.
All couples must be at the high school auditorium between 3:45 p.m. and 4:00 p.m. YOU MUST BE IN
LINE BY 4:00 pm. Please be prompt. The Grand March Ceremony will begin at 4:15 pm. Mrs. O’Neill,
Mr. Gazze and other faculty members will be there to line you up for the Grand March. Please cooperate in
a quiet, orderly manner.
Prom photos will be taken while in line for the grand march.
Students must arrange for their own transportation to Stratigos Banquet Center. Directions will be
included with your tickets. Students must be at Stratigos by 6:00 pm. Dinner will be served by 6:15 pm.
Pre-dinner drinks will be served.
ALL School Rules will apply to the prom.
If school is in session then ALL STUDENTS must be in school on time the day of the prom.
Any student on the Attendance Sanction List on May 7th will not be able to attend the prom and their
money will not be refunded. Any senior who does not have a senior project binder graded by
their advisor and turned in to Mrs. Nelson or Mrs. Yuhas by April 10th will not be able to
attend.
DATE:
TIME:
GRAND MARCH:
PROM:
TRANSPORTATION:
TICKET PRICE:
Friday, May 8th, 2015
4 p.m. – 11 p.m.
Grand March will begin promptly at 4:15 p.m. and will be held
in the Greensburg Salem High School Auditorium.
Stratigos Banquet Center, North Huntington, Pa. Dinner will be
by buffet.
ALL students must provide their own transportation to and from
the prom site.
Tickets will be $150/ couple and $75/ singles.
GREENSBURG SALEM HIGH SCHOOL
65 MENNEL DRIVE
GREENSBURG, PA 15601
(724) 832 –2960
CONTRACT FOR NON-GREENSBURG SALEM STUDENTS
CURRENTLY IN HIGH SCHOOL
OR A GRADUATE
I, _____________________, (A NON-GREENSBURG SALEM STUDENT) WILL BE ATTENDING THE 2014
GREENSBURG SALEM PROM WITH ________________________ (A CURRENT GREENSBURG SALEM
STUDENT). I AGREE TO OBEY ALL OF THE RULES AND REGULATIONS GOVERNING THE PROM
SPECIFICALLY AND ALL GENERAL RULES FOR SCHOOL EVENTS AS STATED IN THE GREENSBURG
SALEM HIGH SCHOOL STUDENT HANDBOOK.
_____________________________
______________________________
SIGNATURE OF NON–STUDENT
SIGNATURE OF GREENSBURG STUDENT
FOR NON – GREENSBURG SALEM ATTENDEES INCLUDING ALUMNI:
CHECK APPROPRIATE ITEM:
______ I ATTENDED ________________________________________________HIGH SCHOOL.
**** (ATTATCH COPY OF DIPLOMA and PHOTO ID) *****
______ I CURRENTLY ATTEND _____________________________________ HIGH SCHOOL.
**** (IF YOU CHECK THIS LINE PLEASE HAVE YOUR CURRENT PRINCIPAL FILL OUT THE INFORMATION
BELOW AND SUBMITT THIS INFO ALONG WITH A PHOTO ID) ****
FOR HIGH SCHOOL PRINCIPAL:
I, __________________________ PRINCIPAL OF _______________________________ HIGH SCHOOL,
ACKNOWLEDGE THAT THE STUDENT LISTED ABOVE IS A MEMBER IN
GOOD STANDING OF _______________________________ HIGH SCHOOL.
_____________________________
PRINCIPAL SIGNATURE