Rock County Prom

Prom Attendee's Guest Registration Form

Guests First Name*

Guests Last Name*

Guests Email*

Guests Birthday*

What school do you go to?*

Who Is Bringing You To Prom? (First and Last name)*

Who Is Your Emergency Contact? (First and last name)*

Guests Emergency Contacts Phone Number*

Guest Agreement Form

1. I have read, understand and commit to following the Code of Conduct for the Rock County
Prom posted on the Homeschool Prom website. I understand that an adult chaperone does not
have to personally witness an inappropriate action on my part. A report from my peer(s)
concerning inappropriate conversation or behavior on my part is sufficient. I accept full
responsibility for my actions and understand that a breach of the code of conduct will result in
my expulsion from the event with no refund.

2. I have read, understand and commit to the Dress Code as posted on the Rock County
Homeschool Prom website. I accept full responsibility for my attire and understand that by
deviating from the Dress Code I will be denied admittance to the prom with no ticket refund.

3. I verify that I meet the age requirements necessary to attend this event.

4. By attending this event I agree to hold harmless any and all organizers of the Rock County
Prom, the chaperones, volunteers, representatives and all members of the Prom Committee in
the event of accident or injury to myself. Additionally, I understand and agree that I am
financially responsible for any damage caused by myself to the event facility or property
regardless of damage being accidental or intentional. I release all officials and professional
personnel from any claim whatsoever on account of first aid treatment or service rendered to
myself in an emergency during participation in the Rock County Homeschool Prom. This
agreement shall be binding on each member of the family, their personal representatives, assigns,
successors, heirs, and next of kin.

Check The Box Below:

By checking this box I recognize that this is my signature agreeing to all the above. By checking this box I will comply with all the agreements listed above.

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Guest's Parents/Guardian Agreements/Waiver

1. I have read and understand what my child signed above, the Code of Conduct and Dress Code
for the Rock County Prom posted on the prom website and have reviewed them with my child. I
understand that an adult chaperone does not have to personally witness an inappropriate action
by my child - a report from his/her peer concerning inappropriate conversation or behavior is
sufficient. I understand and agree that a breach of conduct or inappropriate dress on the part of
my child will result in their needing to be picked up by me immediately, with no ticket refund.

2. I, binding on me as the parent and on any of my minor children attending the event, I agree to hold harmless and indemnify each and all of the parties referred to above from any and all liability, loss, claim, damage and cause of action and I release said parties on
behalf of the minor(s) listed above.

Please Type your name as acknowledgement and agreement to all of the above.

Today's Date