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Smithtown High School West Senior Prom Contract
Tuesday, June 23, 2015 ~ 7:00–11:00P.M.
Carlyle on the Green ~ 99 Quaker Meeting House Rd, Farmingdale, NY 11735
Phone: (516) 501-9700
Student Name: ________________________
Contact (Cell) Phone: ______________
Class of 2015 Advisors ~ (631) 382-3020
Mrs. Kate Baker (Kbaker@smithtown.k12.ny.us) Mrs. Sara Peattie (speattie@smithtown.k12.ny.us)
Student: I AGREE TO AND UNDERSTAND THE FOLLOWING TERMS:
(1) I may purchase one ticket for myself and up to one guest and understand that I must arrive at the event on time but no later
than 7:30pm.

My Guest must agree to these terms and sign and complete the separate Guest Contract;

I am responsible for ensuring that my guest displays responsible & appropriate behavior.
(2) I agree to adhere to the highest standards of behavior and to obey all Smithtown School District rules and regulations.
Anyone not adhering to any school rules or regulations will be subject to strict disciplinary action.
(3) I will wear appropriate semi-formal / formal attire.
(4) I understand that participation in school events/activities is a privilege that is earned and that is contingent upon my positive,
responsible behavior at this event.
(5) I will not use tobacco products.
(6) I understand that I will not be permitted to enter or to stay at the event if I appear under the influence of alcohol or any illegal
substance upon arrival or at any time during the event.
(7) I agree to let Smithtown Central School District Security/Staff search me/my belongings.
(8) I understand that I must remain inside the designated areas within the facilities during the event. Upon exiting the building, I
will not be able to re-enter.
(9) If I do not comply with the Contract terms, I will be removed from the event, picked up early by my parents/guardians, be
subject to disciplinary action, and I will not receive a refund.
(10) I agree to call my parents/guardians for advice and/or transportation at any time if I am ever faced with a situation in which
a driver is/has been under the influence of drugs or alcohol.
(11) I understand that ticket swapping is not permitted.
(12) I understand that the librarian must sign this contract and I have no overdue items to return.
(13) I understand that once a ticket is purchased there are NO refunds for any reason.
(14) I will not consume alcohol or use any type of drugs. Any student, for whom there is reasonable suspicion of the use of
alcohol prior to or during an extra-curricular, inter-scholastic, or other school-related function, whether conducted on or away
from school property, may be required to submit to an alcohol detection test. If I am found to be in possession of or under the
influence of alcohol or drugs, in addition to suspension from school, I may forfeit my eligibility for future privileges; this includes
participation in the graduation ceremony.
______________________
Student Signature
_________________________
*** Library Clearance
___________________________
Assistant Principal *** (Required)
Parent: I AGREE TO / UNDERSTAND THE FOLLOWING TERMS:
(1) I agree to provide transportation for my child at any time from this event without question or argument.
(2) I understand that if my child does not comply with the terms of this contract, I will be called to pick up him/her from the event,
he/she will be subject to strict disciplinary action and that he/she will not receive a refund.
(3) I understand that participation in school events and activities is a privilege that is earned and that is contingent upon my
child’s positive, responsible behavior at this event and other school events.
(4) I have read and understand the Suffolk County Social Host Law information included in this packet and will fully comply with
the contents of the law.
(5) I understand that once a ticket is purchased there are NO refunds for any reason.
(6) Any student, for whom there is reasonable suspicion of the use of alcohol prior to or during an extra-curricular, interscholastic, or other school-related function, whether conducted on or away from school property, may be required to submit to
an alcohol detection test. I give consent for school personnel to use an alcohol detection device on my son/daughter if there is
reasonable suspicion that he/she consumed alcohol. I understand that if my son/daughter is found to be in possession of or
under the influence of alcohol or drugs, in addition to suspension from school, he/she may forfeit his/her eligibility for future
privileges; this includes participation in the graduation ceremony.
___________________
__________________________
__________________________
Parent/Guardian Signature
Parent Contact (Cell) Phone
Parent Contact (Home) Phone
Ticket cost $90.00 each. Please make checks payable to: Smithtown High School West Class of 2015
Tickets will be sold in E-Commons from, Monday, May 18th - Friday, May 22nd
***Last day tickets will be sold is on Friday May 22, 2015***
Guest Contract for the
Senior Prom 2015
The Smithtown Central School District defines the standard of behavior that is expected at all school activities and events in
its Code of Conduct. Copies of the Code of Conduct are available at the district’s Central Office and in the Main Office of the
Western Campus.
In attending the 2015 Senior Prom, I agree to adhere to the standards of behavior as stated in the district’s Code of Conduct.
I further pledge to obey all school rules and regulations while participating in this event.
Any student who displays inappropriate behavior while entering or attending the prom may be denied access. Students who
exhibit any indication of the effects of tobacco, alcohol or illegal substance use will forfeit the right to attend and/or remain
at the Prom. Parents will be notified immediately and will be expected to remove their child from the facility. Appropriate
disciplinary action will be taken by school administrators in accordance with the Code of Conduct. No refunds will be given.
A security inspection and bag check will take place at the event. After entering the event, students will not be allowed to
leave and re-enter.
Students and guests are expected to dress in an appropriate manner. Formal or semi-formal (jackets and
ties are expected for men, dresses are expected for women.)
HSW Student (please print): ____________________________________________________________________
Guest Information ***Copy of photo ID is required
Name of Guest: ______________________________ Signature: _________________________________________
Address: __________________________________________________________________________________
School: ______________________________ Age of Guest: ____ (No one over the age of 20 is permitted to the event)
To be Completed by the Parent/Guardian of Guest
I am aware that my son/daughter will be attending the Smithtown HS West Senior Prom on Tuesday, June 23, 2015 at Carlyle
on the Green as the guest of the above named Smithtown West student. I am aware that I must be available on the evening
of the event.
Guest Parent Name: ____________________________ Guest Parent Signature: ___________________________
Parent Phone for June 23, 2015 between 7pm - 11pm: _________________________________________________
To be Completed by the Guest Attending College or Employed
Name of Guest: _______________________________________Age of Guest: ___________________________
College Attending/Employer: ____________________________Telephone: ______________________________
(No one over the age of 20 is permitted to the event)
To be Completed by a School Administrator at Guest’s School
Signature of Administrator: _______________________________________________
Name, Title, and Phone Number: ________________________________________________________________________________________________
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