Timeless Twenties Bethel Park Prom 2013 This packet contains all necessary forms to attend Prom 2013. Only those with completed packets may purchase tickets. Tickets will be sold Monday, April 22nd – Friday, May 3rd in the Activities Office in the cafeteria during HOMEROOM and LUNCH PERIODS 5, 6, and 7. You must complete and return the following when purchasing your tickets:  Copy of photo ID for both you and your guest  Your Parent Permission Form/Guest’s Permission form  Non-Bethel Park Student Permission Form (if applicable)  Emergency Contact Form  Early Release from Prom Form (only if leaving before 11 pm)  Early Release from School Form  T-Shirt Order Form  Cash or check made payable to “Bethel Park Activities Fund” for $65 per ticket  Prom receipt  Meal Choices for Dinner  Seating List for Dinner Also attached is a nomination form for Class Song and Prom King & Queen. Please return these to the box in the Attendance Office no later than Friday, May 3rd Submit your photos for the Senior Slide Show at [email protected]

Please remember that you MUST arrive and check-in at the Westin Convention Center no later than 6:30 p.m. Late arrivals will not be permitted to attend the prom.

Timeless Twenties Bethel Park Prom 2013 Friday, May 17, 2013 5:30 pm - 11:30 pm Westin Convention Center Hotel (ALL STUDENTS MUST BE CHECKED IN BY 6:30 PM) As we get ready to celebrate the BPHS Prom for the class of 2013, the high school administration and the prom planning committee’s goal is to have a safe and memorable event. Due to the magnitude of the event, there are rules that must be followed to guarantee a safe and successful evening: 1. This is a school sponsored event. As such, the policies of the BPHS Student Handbook are in effect for all participants. 2. Students must turn in the ”Permission to Leave Prom Early” form signed by a parent or guardian (included in prom packet) in order to leave the prom before 11:00 pm 3. All participants attending the prom must register upon arriving and sign out upon leaving the prom. When attendees leave the prom, they must sign out. Once a person signs out, he or she cannot return to the venue. 4. All students and guests attending the prom MUST present a current valid photo ID at check-in. Acceptable forms of identification include a driver’s license, student identification, passport, or state issued identification card. 5. Drug or alcohol possession or consumption will not be tolerated and will be dealt with by a criminal action initiated by the Local Police Dept. The incident will also fall under the school district’s Drug & Alcohol Policy, which will affect a senior’s ability to participate in graduation exercise. 6. The possession or use of tobacco products will not be permitted. 7. Student attire must remain appropriate throughout the evening. Students are required to follow the dress code in the Student/Parent handbook, particularly pages 23-24. Low cut tops exposing the chest or shirts (dresses) exposing the bare midriff are not permitted. Similarly, dancing and student interactions must be socially appropriate at all times. (Provocative interactions that can be viewed as suggestive or physically offensive will not be tolerated.) 8. Prom participants will be excused from school by 11 am on Friday, May 17th. Students must turn in the “Early Release from School” form signed by a parent or guardian (included in prom packet) to be eligible for early release from school on Friday, May 17th. 9. Students who are not in attendance at school (Period 1-3) on Friday, May 17th, will not be permitted to attend the prom. 10. ALL OBLIGATIONS MUST BE CLEARED BEFORE YOU MAY PURCHASE A TICKET.

The school administrators, faculty chaperones, school security, as well as the attending Bethel Park Police Officer and City of Pittsburgh Police Officers will enforce the above rules. You cooperation is essential in make the event memorable and successful.

Parent Permission to Attend Prom STUDENT NAME: ___________________________________________________________ STUDENT’S ADDRESS: ________________________________________________________ PHONE NUMBER WHERE AN ADULT CAN BE REACHED: _________________________________

Your Name Parent/guardian statement: I am giving permission for _______________________________(student’s name) to attend the Bethel Park High School Senior Class Prom on May 17, 2013 at the Westin Convention Center, 1000 Penn Ave., Pgh., PA 15222 from 6:30 pm – 11:30 pm. I understand that it is the student’s responsibility to arrange transportation home at the conclusion of the prom at 11:30 pm. I am also aware that Junior Licenses are not valid after 11 pm. Parent/Guardian Signature___________________________________________

Date:____________________

Student’s Statement: I am requesting permission to attend the Bethel Park High School Senior Class Prom on May 17, 2013 at the Westin Convention Center, 1000 Penn Ave., Pgh., PA 15222 from 6:30 pm – 11:30 pm. I realize this event is a school-sponsored function and I agree to abide by all the rules and regulations established by the Bethel Park School District. This includes, but is not limited to: proper dress, responsible behavior, no smoking, no use of alcoholic beverages, and no use of illegal drugs. Student’s Signature: ______________________________________________

Date: _____________________

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Guest’s Name Parent/guardian statement: I am giving permission for _______________________________(student’s name) to attend the Bethel Park High School Senior Class Prom on May 17, 2013 at the Westin Convention Center, 1000 Penn Ave., Pgh., PA 15222 from 6:30 pm – 11:30 pm. I understand that it is the student’s responsibility to arrange transportation home at the conclusion of the prom at 11:30 pm. I am also aware that Junior Licenses are not valid after 11 pm. Parent/Guardian Signature___________________________________________

Date:____________________

Student’s Statement: I am requesting permission to attend the Bethel Park High School Senior Class Prom on May 17, 2013 at the Westin Convention Center, 1000 Penn Ave., Pgh., PA 15222 from 6:30 pm – 11:30 pm. I realize this event is a school-sponsored function and I agree to abide by all the rules and regulations established by the Bethel Park School District. This includes, but is not limited to: proper dress, responsible behavior, no smoking, no use of alcoholic beverages, and no use of illegal drugs. Student’s Signature: ______________________________________________

Date: _____________________

Non-Bethel Park Student Permission Form *TO BE COMPLETED ONLY IF YOUR GUEST DOES NOT ATTEND BPHS*

BP Student’s name: _________________________________________ Homeroom: _______________ BP Student’s Address: __________________________________________________________________ BP Student’s Phone Number: ____________________________________________________________

STUDENT FROM ANOTHER HIGH SCHOOL: Must have a signature from a current administrator verifying the following: the above individual attends this high school and is known to be of sound character. In my professional opinion, he/she will abide by all rules and regulations governing your prom. Student Name: _______________________________________________

Grade: ________________

High School Name:____________________________________________________________________ Administrator’s Signature: ______________________________________________________________ Administrator’s Name: _________________________________________

Date: _________________

FORMER BPHS STUDENT: (Application will be reviewed by Dr. Jansante-maximum guest age is 21) Name: ______________________________________________________________________________ Year of Graduation: _______________ Phone Number: ______________________________________ Address: ____________________________________________________________________________

GUESTS NOT CURRENTLY ATTENDING HIGH SCHOOL: (maximum guest age is 21) Name: _______________________________________________________ Birthdate: _____________ Phone: _____________________________________________________________________________ Address: ____________________________________________________________________________

Emergency Contact Information Your Name Please neatly print the information below:

Your name: ________________________________________________________ EMERGENCY Contact Name: ________________________________________________ Relationship to attendee: _____________________________________________ Phone Number(s) Where Emergency Contact Can Be Reached During Prom: _____________________________________ _____________________________________ ---------------------------------------------------------------------------------------------------------------------

Emergency Contact Information Guest’s Name Guest’s Name: ________________________________________________________ EMERGENCY Contact Name: ________________________________________________ Relationship to attendee: _____________________________________________ Phone Number(s) Where Emergency Contact Can Be Reached During Prom: _____________________________________ _____________________________________

Early Release from Prom Form *To be completed only if you and/or your guest need to leave Prom before 11:00 pm* This form is required for Bethel Park High School Students only. If both the senior (who purchased the tickets) and his or her guest are Bethel Park High School students, then both students must turn in an Early Leave from Prom Form in order to leave before 11:00 pm. Please allow my son or daughter permission to leave at or after the below indicated time from the Bethel Park High School Prom on Friday, May 17, 2012. I realize that once my child leaves the prom site at the Westin Convention Center that Bethel Park High School is not responsible. Student Name: ____________________________________________ Homeroom: _______________ Parent’s Signature: _________________________________________ Date: _____________________ Early Release Time: _______________________

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Early Release from Prom Form *To be completed only if you and/or your guest need to leave Prom before 11:00 pm* This form is required for Bethel Park High School Students only. If both the senior (who purchased the tickets) and his or her guest are Bethel Park High School students, then both students must turn in an Early Leave from Prom Form in order to leave before 11:00 pm. Please allow my son or daughter permission to leave at or after the below indicated time before the from the Bethel Park High School Prom on Friday, May 17, 2012. I realize that once my child leaves the prom site at the Westin Convention Center that Bethel Park High School is not responsible. Student Name: ____________________________________________ Homeroom: _______________ Parent’s Signature: _________________________________________ Date: _____________________ Early Release Time: _______________________

Early Release from School Form for Friday, May 17, 2013 Please allow my son/daughter to leave school after the Prom Meeting (approx. 10:30/11:00 am) on Friday, May 17th, 2013 to attend the Bethel Park High School Prom. Thank you for understanding that the extra time is needed to prepare for the event. ________________________________________________ Student’s Name (print)

___________________ Homeroom

________________________________________________ Parent Signature

___________________ Date

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Early Release from School Form for Friday, May 17, 2013 Please allow my son/daughter to leave school after the Prom Meeting (approx. 10:30/11:00 am) on Friday, May 17th, 2013 to attend the Bethel Park High School Prom. Thank you for understanding that the extra time is needed to prepare for the event. ________________________________________________ Student’s Name (print)

___________________ Homeroom

________________________________________________ Parent Signature

___________________ Date

T-Shirt Order Form As part of your gift bag, you will receive a prom t-shirt. Please indicate which size you and your guest would like so that we may order accordingly. Please be sure to note the correct size. You will not be able to exchange shirts if you order the incorrect size.

Your name: _____________________________________________________________ (Name of person who purchased tickets) Please mark an “X” next to the t-shirt size you’d like to order: _____________

Small

_____________

Medium

_____________

Large

_____________

XL

_____________

XXL

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T-Shirt Order Form Your guest’s name: _______________________________________________________ Please mark an “X” next to the t-shirt size your date would like: _____________

Small

_____________

Medium

_____________

Large

_____________

XL

_____________

XXL

Receipt for Payment Timeless Twenties Prom 2013 Please fill-out the information below before you purchase your prom tickets. Ticket prices are $65 per person.

Your Name: ____________________________________________________ Your Homeroom: ________________________________________________

Guest’s Name: _______________________________________________ Homeroom/School: ______________________________________________ -FOR OFFICE USE ONLYSignature of Ticket Seller: _________________________________________ Amount Paid: $_____________

Prom tickets can be purchased in the Activities Office in the cafeteria from Monday, April 22nd until Friday, May 3rd during homeroom or lunch periods 5, 6, and 7. Only cash or checks made out to the “Bethel Park Activities Fund” will be accepted. Please write “Class of 2013” on memo line. Tickets are nonrefundable after Friday, May 3rd, 2013.

Meal Choices Timeless Twenties Prom 2013

Choice 1: Italian Marinated Chicken-Grilled Boneless Breast of Chicken Marinated in Italian Seasonings Choice 2: Penne Pasta Primavera-Penne Pasta and Julienne Vegetables Tossed with Alfredo Sauce Choice 3: New York Strip Steak-Grilled Medium Rare and Served with a Four-Peppercorn Sauce All meals include a side salad, starch, fresh vegetable, roll, dessert, and soda bar.

Your Name: _____________________________

Your Guest’s Name: _____________________________

Please mark an “X” next to the meal you would like:

Please mark an “X” next to the meal you would like:

________ Italian Chicken

________ Italian Chicken

________ Pasta Primavera

________ Pasta Primavera

________ NY Strip Steak

________ NY Strip Steak

If you or your guest has any diet restrictions, such as vegan, gluten-free, food allergies, etc., please select a meal from above and explain your special dietary needs below. We will either adjust your chosen meal or provide you with an alternate meal. ________________________________________________________________________ ________________________________________________________________________

Seating List for Dinner Timeless Twenties Prom 2013

 Only 1 paper needs to be turned in for everyone at your table.  If you do not list 10 people, then you will be combined with other groups.  If your name is on multiple lists, the advisors will choose what table you will sit at. Name of people to sit with (list up to 10 people): (1) _________________________________ (2) _________________________________ (3) _________________________________ (4) _________________________________ (5) _________________________________ (6) _________________________________ (7) _________________________________ (8) _________________________________ (9) _________________________________ (10) _________________________________ Song & Prom Court Nominations

Timeless Twenties Prom 2013 Please write your nominations for the following categories and submit them in the nomination box in the Attendance Office no later than Friday, May 3rd, 2013.

Your Vote

Guest’s Vote (only if a BP Senior)

Class song:

Class song:

 Send Me on My Way-Rusted Root

 Send Me on My Way-Rusted Root

 Bittersweet Symphony-The Verve

 Bittersweet Symphony-The Verve

 Time of Your Life (Good Riddance)-Green Day

 Time of Your Life (Good Riddance)-Green Day

 All the Small Things-Blink 182

 All the Small Things-Blink 182

 Other: ____________________________

 Other: ____________________________

Prom King:

Prom King:

_________________________________

_________________________________

Prom Queen:

Prom Queen:

_________________________________

________________________________