Homecoming Dance Non-Xavier Guest Form

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STUDENTS MUST BE LOGGED INTO THEIR SCHOOL GOOGLE ACCOUNT TO COMPLETE THIS FORM!

DATE: Saturday, September 13

TIME: Dance is 8:00-10:30, it is a lock in. Doors open at 7:30pm for pictures. Doors lock from 8:15pm-10:15pm.

Cost: $10.00 each

One guest per Xavier student.
No guests below grade 10.
No guest may be older than 20 on the day of the dance.
Guests must be in good standing at their school to attend.
Xavier students are responsible for the behavior of their guests.
Xavier student must enter the dance with their guest.
Only physical IDs for guests will be accepted for entry. YOU WILL NOT BE ALLOWED TO ENTER THE DANCE WITHOUT AN ID.
Bags will not be allowed, small purses are subject to be searched.
Please read the rules and guidelines in the Xavier handbook on school dances. LINK

A copy of this form will be sent to your email when completed, SAVE THAT EMAIL as your receipt.

Email *

Record my email address with my response

Xavier Student First Name *

Xavier Student Last Name *

Guest First Name *

Guest Last Name *

Guest Current School *

Jefferson

Washington

Metro

Kennedy

Linn-Mar

Prairie

Marion

Benton Community

Iowa City High

Iowa City West

Iowa City Liberty

Central City

Center Point - Urbana

North Linn

HS Graduate

Other:

Guest School Principal's email *

Guest Date of Birth *

Guest Parent First and Last Name *

Guest Parent Cell Number *

Guest Parent Email *

I certify that I have read and will follow the description at the top of this page and the student handbook section on school dances. *

Yes

Required

A copy of your responses will be emailed to .

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