FORM A
Garden City High School Senior Prom Contract 2017-GCHS SENIOR
Acknowledgement of having read 1.) The Garden City School Board of Education Policy # 5440 on Drug and
Alcohol Abuse as well as 2.)The Garden City High School Disciplinary Code of Conduct as found in the Garden City
High School Planner pages 27-28
This form is to be completed by the 1.) GCHS senior prom attendee and 2.) the legal guardian of said senior .
This signed form must be handed in before ticket purchase. Signed contracts due by Thursday, May 25.
Policy #5440 DRUG AND ALCOHOL ABUSE
The Board of Education is committed to the prevention of alcohol and other substance use/abuse. This policy describes the philosophy of
the district and the program elements the district will use to promote healthy life styles for its students and to inhibit the use/abuse of alcohol
and other substances.
No student may use, possess, sell, offer, manufacture, or distribute alcohol or other substances, nor may use or possess drug paraphernalia,
on school grounds or at school-sponsored events, except drugs as prescribed by a physician. The term “alcohol and/or other substances”
shall be construed throughout this policy to refer to the use of all substances including, but not limited to, alcohol, inhalants, marijuana,
cocaine, LSD, PCP, amphetamines, heroin, steroids, look-alike drugs, and any synthetic version thereof (whether or not specifically illegal or
labeled for human consumption), commonly referred to as “designer drugs.” Designer drugs are those substances which have been designed
and synthesized to mimic the intended effects and usages of, and which are chemically substantially similar to, substances controlled by
federal and/or state law as exemplified above. The inappropriate use of prescription and over-the-counter drugs shall also be prohibited.
Additionally, the following persons shall be prohibited from entering school grounds or school-sponsored events: any person exhibiting
behavior, conduct, or personal or physical characteristics indicative of having used or consumed alcohol and/or other substances, or any
person who school personnel have reasonable grounds to suspect has used alcohol and/or other substances.
In order to educate students on the dangers associated with substance abuse, the health education curriculum shall include instruction
concerning drug abuse for grades K-12.
Any staff member observing narcotics possession or usage by students shall report the incident immediately to the Superintendent of Schools
or his/her designee. The Superintendent or his/her designee shall then seek immediate action. Any narcotics found shall be confiscated
immediately, followed by notification of the parent(s)/guardian(s) of the student(s) involved and the appropriate disciplinary action taken,
up to and including permanent suspension and referral for prosecution. In its effort to maintain a drug-free environment, the district shall
cooperate to the fullest extent possible with local, state and/or federal law enforcement agencies.
The district will use the following principles as guides for the development of its substance use/abuse prevention efforts and for any
disciplinary measures related to alcohol and other substances:
• Alcohol and other substance use/abuse is preventable and treatable.
• Alcohol and other substance use/abuse inhibits the district from carrying out its central mission of educating students.
• The behavior of the Board, the administration, and all school staff should model the behavior asked of students.
• While the district can and must assume a leadership role in alcohol and other substance use/abuse prevention, this goal will be
accomplished only through coordinated, collaborative efforts with parents, students, staff, and the community as a whole.
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FORM A
Garden City High School Senior Prom Contract 2017-GCHS SENIOR
This form is to be completed by the 1.) GCHS senior prom attendee and 2.) the legal guardian of said senior.
This signed form must be handed in before ticket purchase. Signed contracts due by Thursday, May 25.
For Parents
As a parent of a senior attending the 2017 Garden City High School Pre-Prom and Prom, I understand the interest
of the faculty, administration, and PTA to have a safe prom that is alcohol and drug free. I acknowledge that I have
had the opportunity to be informed of the school’s concerns and rules. I am aware that all students who wish to
attend Graduation must attend Graduation Rehearsal. All students who wish to attend the Prom must attend the
Pre-Prom, and that parents are invited to attend Pre-Prom. I also will discuss my child’s post prom plans with
him/her. I understand that there will be consequences for poor behavior at Pre-Prom, Prom, Graduation Rehearsal
or Graduation, which may include exclusion from Graduation Exercises, removal from Honor Societies, and/or a
letter to the graduate’s chosen college informing them of the behavior.
Parent’s name______________________________________________________________________
Parent’s signature___________________________________________________________________
Parent’s phone number in case of an emergency on prom night______________________________
Emergency contact (other than parent listed above)
Name_____________________________________________________________________________
Phone number _____________________________________________________________________
For Students
As a Garden City High School member of the Class of 2017, I understand that I must attend the Graduation Rehearsal
at 9:00 a.m. on Friday, June 23, 2017 if I wish to participate in Commencement Exercises. I must attend the PreProm if I wish to attend the Prom. I understand that there will be consequences for poor behavior which may include
exclusion from Graduation Exercises, removal from Honor Societies, and/or a letter to the graduate’s chosen college
informing them of the behavior.
Student’s name_____________________________________________________________________
Student’s signature__________________________________________________________________
Are you bringing a guest?
Yes __________
No __________
If yes, name of guest __________________________________________
Is guest a GCHS student?
Yes __________
No __________ If yes, grade__________
If no, name of school__________________________________________
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FORM B
Garden City High School Senior Prom Contract 2017-GUEST
Acknowledgement of having read 1.) The Garden City School Board of Education Policy # 5440 on Drug and
Alcohol Abuse as well as 2.)The Garden City High School Disciplinary Code of Conduct as found in the Garden City
High School Planner pages 27-28
This form is to be completed by the 1.) GUEST of the GCHS senior prom attendee and 2.) the legal guardian of said
guest .
This signed form must be handed in before ticket purchase. Signed contracts due by Thursday, May 25.
Policy #5440 DRUG AND ALCOHOL ABUSE
The Board of Education is committed to the prevention of alcohol and other substance use/abuse. This policy describes the philosophy of
the district and the program elements the district will use to promote healthy life styles for its students and to inhibit the use/abuse of alcohol
and other substances.
No student may use, possess, sell, offer, manufacture, or distribute alcohol or other substances, nor may use or possess drug paraphernalia,
on school grounds or at school-sponsored events, except drugs as prescribed by a physician. The term “alcohol and/or other substances”
shall be construed throughout this policy to refer to the use of all substances including, but not limited to, alcohol, inhalants, marijuana,
cocaine, LSD, PCP, amphetamines, heroin, steroids, look-alike drugs, and any synthetic version thereof (whether or not specifically illegal or
labeled for human consumption), commonly referred to as “designer drugs.” Designer drugs are those substances which have been designed
and synthesized to mimic the intended effects and usages of, and which are chemically substantially similar to, substances controlled by
federal and/or state law as exemplified above. The inappropriate use of prescription and over-the-counter drugs shall also be prohibited.
Additionally, the following persons shall be prohibited from entering school grounds or school-sponsored events: any person exhibiting
behavior, conduct, or personal or physical characteristics indicative of having used or consumed alcohol and/or other substances, or any
person who school personnel have reasonable grounds to suspect has used alcohol and/or other substances.
In order to educate students on the dangers associated with substance abuse, the health education curriculum shall include instruction
concerning drug abuse for grades K-12.
Any staff member observing narcotics possession or usage by students shall report the incident immediately to the Superintendent of Schools
or his/her designee. The Superintendent or his/her designee shall then seek immediate action. Any narcotics found shall be confiscated
immediately, followed by notification of the parent(s)/guardian(s) of the student(s) involved and the appropriate disciplinary action taken,
up to and including permanent suspension and referral for prosecution. In its effort to maintain a drug-free environment, the district shall
cooperate to the fullest extent possible with local, state and/or federal law enforcement agencies.
The district will use the following principles as guides for the development of its substance use/abuse prevention efforts and for any
disciplinary measures related to alcohol and other substances:
• Alcohol and other substance use/abuse is preventable and treatable.
• Alcohol and other substance use/abuse inhibits the district from carrying out its central mission of educating students.
• The behavior of the Board, the administration, and all school staff should model the behavior asked of students.
• While the district can and must assume a leadership role in alcohol and other substance use/abuse prevention, this goal will be
accomplished only through coordinated, collaborative efforts with parents, students, staff, and the community as a whole.
1
Form B
Garden City High School Senior Prom Contract 2017
For Guest-GCHS student grades 9, 10 or 11
or non-GCHS guest (under 21 years of age)
This signed form must be handed in before ticket purchase. Signed contracts due by Thursday, May 25.
Name of GCHS Senior _______________________________________________
If a member of the Class of 2017 wishes to bring a guest to the Pre-Prom and Prom, please be advised that your
guest must agree to and adhere to all of the rules and procedures outlined for our seniors. No guests will be
permitted 21 years of age or over without the permission of the principal.
Prom guest name and grade_________________________________________________________________
Guest signature __________________________________________________________________
Parent/Guardian of guest
Name________________________________________________________________________________
Contact information ______________________________________________________________
Parent/Guardian signature__________________________________________________________
Principal/Assistant Principal of guest
Signature__________________________________________________
School ____________________________________________________ Grade_______________
Please include a photocopy of guest’s driver’s license or school ID. (For Non-GCHS Students)
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