Prom Chaperone Request

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This form is to request to be a volunteer chaperone for our 2024/2025 prom. Please read through the guidelines listed below before completing this form. Once your form has been submitted and reviewed, you will then be contacted by a prom committee chair member to let you know if your request has been approved or denied.

Contact: [email protected]

The responsibilities of the chaperone include but are not limited to:

All chaperones must complete a background check through Protect My Ministry.
Arrive at the designated time where there will be a brief chaperone meeting where assignments will be issued.
Remain until prom has ended.
Ensure that only students who have purchased tickets and authorized chaperones are in attendance.
Formal, modest attire is required and must be worn for the duration of prom.
No attendee will possess, use, distribute, sell, or be under the influence of alcohol, drugs, tobacco, or any controlled substance.
Ensure that students are behaving respectfully and appropriately. Any behavior deemed inappropriate may result in expulsion from prom. In this extreme case, please inform the prom chairs Bonnie Simpson or Laura Coleman.

1. *	Name:

2. *	Phone:

3. *	Email:

4. *

I confirm that I have read the above guidelines and agree to abide by them. I also agree to complete the criminal background check should my volunteer chaperone request be approved.

YES

I have more questions and need to contact a committee chair.