DOUGHERTY VALLEY HIGH SCHOOL
10550 Albion Road, San Ramon, CA 94582
(925) 479-6400 * FAX (925) 479-6597
DOUGHERTY VALLEY HIGH SCHOOL - GUEST PASS DANCE AGREEMENT
October 22, 2011
7:00pm – 10:00pm
IMPORTANT YOU MUST COMPLETE THIS FORM ONLY IF YOU ARE BRINGING A NON - DVHS GUEST:
A. Students may only bring 1 guest.
B. Form must be completed and returned in order to purchase dance tickets. Student ID’s must be present when
C. ID cards must be presented at the door in order to enter the dance. Students not in school must present a driver’s license
and or ID card.
D. All school rules apply to this dance.
E. Signatures below hold the individuals responsible and accountable for their actions. School rules violated by
students may result in disciplinary action.
DVHS student purchasing ticket (please print)______________________________________________Ticket purchaser’s grade_____
DVHS parent/guardian signature and evening telephone number____________________________________________________
GUEST STUDENT - (ATTENDS ANOTHER HIGH SCHOOL OR IS OUT OF SCHOOL AND UNDER 21 YEARS OF AGE)
Your guest’s name (please print)_____________________________________________Home telephone (______)__________________
Home address___________________________________________________________ City ___________________________________
Signature of guest’s parent/guardian________________________________________ Name of guest’s high school ________________
Guest students who do not attend a high school and are under the age of 21 must give a photo copy of their Identification/Drivers
License when tickets are purchased.
GUEST SCHOOL SIGNATURE
Yes, this student is in good standing at our high school
Guest school’s telephone (______)_____________________
Guest’s school administrator signature and title________________________________
(please attach a business card)
SCHOOL ADMINISTRATOR BUSINESS CARD
Purchase Tickets from DVHS Bookkeeper