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ProjectPromPermissionSlip_2012 by ajizai

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									                                        2012 Project Prom Permission Slip

Following the Adrian Prom, the Project Prom committee is hosting a party at Dave & Buster’s which is located
at 1843 Village West Parkway in Kansas City, KS. Students and their guests will be transported from the Adrian
Optimist Bldg by bus/PP Committee vehicle to the city at approx. 11 p.m. They will then return back to the
Adrian School parking lot at approx. 6 a.m. If you would like to attend this fun filled event complete with food,
games, and prizes, fill in the following information and return to the high school office by Wed. April 10, 2012
to guarantee your t-shirt order. You may attend this event even if you do not go to prom, but you must meet
the eligibility requirements laid out by the Adrian R-3 School District, turn in a completed form and be ready
for pick up at 11:15 p.m. on the south side of the school by the commons area. For more info, contact Kellie
Case 816-297-4451 or Angie Loughridge 816-297-4218.

__________________________________________________________________________________________
FREE T-Shirt Information
Student       Small      _____                                               Guest         Small     _____

               Medium _____                                                                Medium _____

              Large      _____                                                             Large      _____

              X-Large    _____                                                             X-Large _____

              2X-Large    _____                                                            2X-Large _____

Extra T-shirts are available at a cost of $12 each and should be ordered at this time. Include payment with
this form and specify the the size and number you are purchasing. Make checks payable to Adrian Project
Prom.

Small____ Medium____ Large____ X-Large____ 2X-Large____                     Amount enclosed $______

Student Permission

I give__________________________ permission to attend Project Prom 2012. I understand that my child will
sign in when they board the bus/PP Committee vehicle and adhere to the rules and policies of Project Prom
(see attachment). I am available in case of an emergency at the following number(s).

___________________________                 ______________________           _______________________
Parent/Guardian                             Contact #                        Second Contact #

Guest Permission

I give__________________________ permission to attend Project Prom 2012. I understand that my child will
sign in when they board the bus/PP Committee vehicle and adhere to the rules and policies of Project Prom
(see attachment). I am available in case of an emergency at the following number(s).

___________________________                 ______________________           ________________________
Parent/Guardian                             Contact #                        Second Contact #

								
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