Thornridge High School
Date Request Form
Prom 2012 – “It Seems Like Just Yesterday”
A Thornridge student requesting to bring a date/guest who is not a Thornridge student must have this form filled out
and presented to and signed-off by the Student Activities Director.
If the date/guest is a student the completion of the form requires –
the signature of the student
the name of his/her school
the school’s telephone number
the signature of the Thornridge student
the signature of the Thornridge student’s parent/guardian (attesting to the good citizenship of this individual)
If the date/guest is not a student the completion of the form requires –
The date of birth of the date/guest (he/she must be 21 years of age or under)
The signature of the date/guest
The signature of the Thornridge student
The signature of the Thornridge student’s parent/guardian (attesting to the good citizenship of this individual).
As a guest of Thornridge High School, I realize that I must follow all school rules (including the dress
code) and abide by the decisions of the Thornridge Administration and staff.
Date/Guest’s Name (print) _____________________________________Date of Birth _______________________
Signature of Date/Guest _________________________________________________________________________
School that Date/Guest Attends ______________________________ School Phone # _______________________
TR Student’s Name (print) ___________________________________________ Date _______________________
ID # ___________________________________________ Year in School _________________________________
Signature of Thornridge Student __________________________________________________________________
As a parent/guardian of the above Thornridge High School student, I find his/her date/guest to be a
responsible person and I recommend him/her as an exemplary guest for the 2011 Thornridge Prom.
Parent/Guardian’s Name (print) ___________________________________________________________________
Date _____________ Home Phone # __________________________ Cell Phone # _________________________
Signature of Parent/Guardian _____________________________________________________________________
Name of School for Guest/Date ___________________________________________________________________
Director of Student Activity Signature ______________________________________________________________