Department of Education

Region V
Division of Camarines Sur
GOA NATIONAL HIGH SCHOOL
Goa, Camarines Sur

PARENTAL CONSENT
School Year 2022-2023

I/We hereby willingly and voluntarily give consent the participation of my/our son/daughter
in the Seniors Night on April 28, 2023

I have considered the benefits that my son or daughter will derive from his/her participation in this
activity provided that due care and precaution will be observed to ensure the comfort and safety of my
son/daughter and that DepEd Employees and personnel may not be held responsible for any untoward incident
that may happen beyond their control.

To assure a positive and memorable evening for all attendees, students and their guests are expected to
have exemplary behavior. Failure to follow the rules may result in the student/guest being removed from the
dance. Any major discipline issues will be dealt with through the proper administrative channels. Below is a
list of guidelines to help make this year’s Junior-Senior Prom a successful event.

1. Students must enter the dance before 7:00 PM and remain until at least 5:00 AM. Students
who leave the dance will not be readmitted. Parents will be notified by phone from an
administrator if students do not arrive by 7:00 PM.
2. All school rules, as well as district, state and federal laws, will be enforced.
3. All students must be in good attendance and behavior standing. Any student with 20 or
more unexcused tardies and/or 18 or more unexcused period absences, even after
purchasing a ticket, will not be permitted to attend. All students must be debt free and have
a 2.0 GPA to attend. Refer to page 27 in the Student Handbook
4. Current year photo ID card or phone with the Q Student ID card pulled up will be your dance ticket
and is required of all CHS students.
5. Appropriate formal attire is required and is at the discretion of school personnel. Attendees
wearing inappropriate attire will be denied access to the dance (including revealing clothing,
dresses that are too short or low cut, jeans, shorts, ripped clothing or baseball caps.)
6.
7. All tickets must be purchased in advance. NO tickets will be sold at the dance. Tickets are
sold in the Activities Office at lunch or online at our Cabrillo web store. Please see the grade
level Google classroom for dates and times. You may not leave class early to purchase a
ticket.
ALL TICKET SALES WILL END ON: Wednesday, April 27th, 2022 at 1:00 PM. (unless sold out)
8. Dancing must be appropriate for high school. Vulgar, obscene, or suggestive dance moves shall
not be displayed. All students will be given a wristband that must be worn when entering the
dance. Violations of the dance policy including inappropriate dancing, will result in a warning
and then removal of the wristband. The second warning will result in a removal from the
dance with no refund.
9. Students may not use or be under the influence of any alcohol, narcotics, or other drugs
(E.C. 48900.2 b, c, h.).
10. All dance attendees are subject to random alcohol detector testing and search.
11. Smoking, including electronic cigarettes and vaping, is not permitted at any Cabrillo High
School event.
12. Pictures may be taken and posted on our Website and/or our Cabrillo Facebook page.
13. Students must leave or be picked up no later than 12:15 AM after the dance.

Student/Guest Name Signature

Parent/Guardian Name
Signature Parent/Guardian
Home Phone # Cell
# Emergency contact: Phone #: