Ticket Form $25.00 per ticket Name: __________________________________________ Phone Number: __________________________________ Email Address: __________________________________ Parent’s Phone Number: ___________________________ Gender? M / F Are You a Member of HEARTS? Y / N If not, who are you a guest of? _______________________________________________ What grade are you in this year? ______________________ What is your date-of-birth? __________________________ Payment Method by check only Check #: __________ Payment Amount: _______ Please mail ticket form, permission form, check payable to Enid Trevithick and a selfaddressed stamped envelope (in order for a ticket to be mailed back to you) to: Jill Brooks, 20982 Homecrest Ct., Ashburn, VA 20147 Questions? 703-858-2989 or jillebeanbrooks@gmail.com Permission Form It is our intent to provide an excellent event for the HEARTS home school community that will allow them to experience an evening of celebration with their friends at the end of the school year. This is a formal affair that is intended for you to get together as a group and enjoy each other’s company as a group. Therefore, we strongly discourage couples from attending the prom as “dates”. We have found that the most fun is had by all when everyone is willing to dance with a lot of different partners. It is also important to treat the evening and other guests with the respect they deserve by dressing in appropriate attire. With this in mind and in order to clearly state our expectations for the evening, each participant must sign the following Dress Code and Code of Conduct. Dress Code:  Men must wear dress slacks, dress shoes, button down shirts and a tie – suit jackets are encouraged, but optional.  Women, out of respect for others, low necklines revealing cleavage and dresses with plunging backs are not permitted. Dresses must be 2 inches below your fingertips.  You may contact Cindy Almario prior to the dance if you have questions about proper attire or on how you may be able to modify a dress to meet dress code.  We reserve the right to refuse entrance to anyone that is not dressed appropriately, so please ensure that you and your guests are adhering to the dress code. Code of Conduct:  “Couples” are discouraged from attending with the intent of being exclusive (only dancing with each other).  Public Displays of affection will be grounds for immediate dismissal without refund.  No smoking, drinking alcohol, or drugs are allowed on the premises before, during, or after the prom.  No outside food or beverages are allowed.  Kindly respect the authority of the Chaperones.  Once you leave the event, you may not return.  Inappropriate or disrespectful conduct will be grounds for immediate dismissal. I ___________________________________________________ have read and agree to abide by the Dress Code and Code of Conduct for the Prom. ____________________________________________________ Student Signature ____________________________________________________ Parent Signature