Northridge Prom Information and Ticket Orders
When: Saturday, May 13th
6:00-10:00 pm
Where: The Skylight
85 E Main Street
Newark, Oh 43055
Ticket Price: $55.00 per person (includes dinner and dance)
Please plan to arrive between 5:55-6:15 pm. King and Queen will be crowned at 6:20 with dinner immediately following.
Ticket Sales:
You must have your tickets purchased by 3 pm Friday, April 28th
All ticket orders must be placed with Mrs. Grow and paid for by 3:00 pm on April 28th. There are no
exceptions to this deadline, as we must work within the guidelines set by The Skylight.
If you have not ordered and paid for your tickets by the deadline, you will not be able to attend prom.
If you are a C-TEC student, you may mail your ticket order and payment to the high
school or drop them off to the office.
Please return this portion of this order form to Mrs. Grow IN AN ENVELOPE by Friday, April 28th WITH
EXACT PAYMENT, as change will not be given.
Name: _________________________________________________________
Guest Name (if purchasing his/her ticket): ______________________________________________________
Non-Northridge Guest:
_______ No
_______ Yes (If yes, please include your Non-Northridge guest form with your order form and payment)
Total MONETARY amount of Prom Tickets $ _________________ ($55.00 each)
Payment Options: Cash or Checks payable to Northridge Local Schools
Northridge High School
Non-Northridge Student Permission Form
Northridge High School Function: Prom
Date/Time/Location: May 13th, 6:00-10:00 pm at The Skylight
Northridge High School students wishing to bring one non-Northridge student date to the above function must receive
approval from the Northridge High School administration. This completed form must be submitted to the
administration by Friday, April 28th and included with the ticket order form and payment. This form must be
completed and approved prior to dance attendance.
All Northridge High School rules will be in effect at this function and are applicable to both the student and the guest.
After entering the building, no one will be allowed to leave the building and return.
Please note that no middle school students are permitted to attend. No guest will be admitted without prior approval.
Northridge Escort Information/Responsibility Statement
Name _______________________________
Phone # (____) ________________
Parent Name: _________________________________________
I understand that I am subject to Northridge High School disciplinary action based on my behavior and the behavior of
my guest.
Signed: ______________________________
Date ______________
Parent/Guardian signature acknowledging understanding of responsibility:
Signed: ______________________________
Date ______________
Non-Northridge Student Information/Responsibility Statement
Name _______________________________
Age _______
School Attending or graduation date______________________________
I understand that I am subject to all Northridge High School and Northridge Local School District rules and responsibilities. I further
understand that my Northridge High School escort is equally subject to disciplinary action based on my behavior and actions.
Signed: _____________________________________
Date____________________
(IF UNDER 18 or CURRENT STUDENT)
My son/daughter has my permission to participate in the function listed above. I understand that I am ultimately
responsible for his/her actions and behaviors. I permit Northridge High School staff and administration to take any
actions necessary to maintain orderly conduct at this function.
Parent Signature ______________________________
Date _______________Phone #(____)___________
Non-Northridge High School Principal Affirmation Statement and School Seal
By affixing my signature and school seal, I hereby attest that the student applying for out of school approval
has maintained acceptable standards, attendance and performance.
Signed __________________________________Date ______________ Phone # ( ___)____________
School Seal