Non-KMHS Student Permission Slip ***This form is only for non

Kennesaw Mountain High School
2015 Junior/Senior Prom
Non-KMHS Student Permission Slip
As part of our continuing efforts to ensure the safety of all our students, we require all non-Kennesaw Mountain Students
attending prom to complete this permission slip and adhere to the following:
****This form must be completed and returned with a photocopy
of YOUR date’s current student
I.D. or state issued I.D. at the time you purchase your prom tickets. Tickets will be sold on
March 4-6 for $75.00 Failure to have this form completed and submitted will result in your date being denied
admittance to the prom.
I understand and acknowledge the following:
1. No alcohol, drugs or tobacco products are allowed at prom. If my date or I arrive at the prom and it is evident that I, or my date,
have been participating in any of the previously mentioned behaviors, the Atlanta Police Department will take that party into
2. I understand that I am responsible for my date, and that all the Cobb County School District Policies also apply to my date.
3. Once I leave the prom, neither myself, nor my date, will be allowed to return.
4. All attire must be deemed appropriate by chaperones and administration. If attire is not appropriate, both myself and my date
will not be permitted to attend prom. If there are concerns about attire, prior approval should be obtained. I have read and understood the dress code guidelines.
5. I understand I must go to the prom with the date I specified when I purchased my tickets.
6. The Cobb County Board of Education Student Code of Conduct applies to any school function including prom.
Please understand that any student not found to be in good standing at his/her home school will not be
allowed to attend Kennesaw Mountain High School Junior/Senior Prom.
KMHS Student Name: _____________________________________________________________________
Non-KMHS Student Name: ________________________________________________________________
Name of High School:______________________________________________________________________
Administrator’s Signature: __________________________________Phone #:__________________________
Parent/Guardian Information:
Parent Name: _____________________________________________________________________________
Parent Signature: __________________________________________________________________________
Parent Contact Number: _____________________________________________________________________
If not currently enrolled in high school:
Individual’s Name & Age: ___________________________________________________________________
Emergency Contact Name and Number: ________________________________________________________
We thank you in advance for your cooperation. Please contact J. LaBroad (6) 594-8190 with questions.
***This form is only for non-KMHS students attending prom.