Cochrane Collegiate Academy

Guest Registration Form: Prom 2015

CCA Student Name _____________________________________________
Grade __________

ID Number _____________ 1st Block ___________

The following information is required in order to determine a guests

eligibility to attend the Cochrane Collegiate Academys Prom:
Guests Full Name_____________________________________________
Guests Date of Birth_________________________________ Age______
School Attending (if applicable) __________________________________
Grade Level ________________
Place of Employment
(if not in high school)
_____________________________
Statement of Good Standing:

All Non-CCA guests must have a completed Character Statement form by a current
school administrator of the attending high school.
If not in high school, the form may
be completed by an employer or college instructor.

If guest is enrolled in a high school a high school administrator must sign the form.

Eligibility statements by relatives or parents of the guest will not be accepted

Guests may not be over the age of 20 at the time of the prom (May 9, 2015)

Guests cannot be a Freshman at any high school

including
Cochrane Collegiate

Academy

Guests may not have criminal convictions and/or actions pending

Guest may not be attending a CMS discipline school (i.e. Turning Point Academy)

A picture ID must be copied and submitted with this application before May 1, 2015

All attendees must present a picture ID on prom night (examples: school/university ID,
DMV Identification Card, or drivers license)

Student Signature ____________________________________________________________

CharacterStatement

________________________________________isastudentoremployeein
goodstandingwithourschool/company.Therearenopendingdisciplinary
actionsagainstthisstudent/employeeatthistime.

________________________________________
SchoolorBusiness

________________________________________
PrintName

________________________________________
SignatureofAdministrator/Employer

______________________________
DaytimePhone

______________________________
Title

______________________________
Date