Prom Permission Slip
Complete this form to provide parental/guardian consent for student participation in the upcoming prom.
Student Full Name
*
First Name
Last Name
Grade
*
Please Select
9th
10th
11th
12th
School Name
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the student have any allergies or medical conditions?
*
No
Yes (please describe below)
If yes, please describe any allergies or medical conditions.
Prom Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How will the student be transported to and from the prom?
*
Parent/Guardian
Student drives self
Rideshare/Taxi
Other (please specify)
Parent/Guardian Signature
*
Submit Permission Slip
Submit Permission Slip
Should be Empty: