SJA GUEST PERMISSION FORM SJA Student Name: _______________________________________
Grade ____________
Form must be submitted at least TWO (2) days prior to the event otherwise guest will NOT be allowed to attend. Procedures for bringing a guest to a Saint Joseph Academy Dance: 1. Only currently enrolled students may attend dances and are permitted to bring 1 guest. 2. Middle School students are NOT permitted to attend high school dances. 3. Guest must fill out the following information and obtain guest, administrator and parent/guardian signatures. SJA students will be able to purchase dance tickets for themselves and their guests once they submit this form. 4. Guests must arrive with SJA student and will need a picture ID to be admitted to the dance. 5. No one will be permitted entrance 1 hour after start time, and students may only leave early if picked up by a parent/guardian. Once a student leaves the dance, he/she may not return.
**************************************************************************** TO BE COMPLETED BY GUEST. Guest’s Name: ______________________________________________________ Guest’s Address:_____________________________________________________ ______________________________________________________________________________ Guest’s Emergency Contact:___________________ Ph#_____________________ **************************************************************************** TO BE COMPLETED BY GUEST’S SCHOOL. Guest’s School:__________________________________
Ph#____________________
Do you recommend that he/she be permitted to attend the SJA Dance? YES Guest school administrator signature:_____________________________________ Guest Guest
School Administrator printed name: school administrator phone #:
NO
_________________________________ _________________________________
I agree to conduct myself in a manner which exhibits appropriate language, dignity, and respectful behavior towards others. I recognize that this is a school sponsored activity and that I am bound by the policies, laws, and procedures of Saint Joseph Academy. This includes submitting to a breathalyzer and the total abstinence of the use/sale of alcohol, tobacco products, vape products, drugs, or controlled substances prior to, while in attendance, or associated with this activity. I further agree to follow any rules or recommendations given by any administrator, faculty, and staff, or adults who are supervising this activity. I understand that violation of this agreement will result in immediate expulsion from this activity, possible police referral, parental contact, and being banned from attending any future Saint Joseph Academy sponsored activities.
________________________________________________________ Guest’s Signature
_______________ Date
________________________________________________________ Guest’s Parent/Guardian Signature (required if guest is under 18)
_______________ Date
________________________________________________________ Guest Parent/Guardian Printed Name
To Be Completed by SJA Administrator/Dance moderator:
SJA Administrator Signature ______________________________________________________ SJA Administrator Printed Name __________________________________________________ SJA moderator initials __________ Date _________________________