Fusion Academy Release Form

Thursday, May 11, 2017

6:30pm -10:30pm
Sunset Terrace @ Chelsea Piers, NYC, NY

Attendance at Prom is a privilege and not a right. All students understand that Fusion Academy Administration reserves the
right to conduct appropriate searches, deny entry or remove students from this event at the sole discretion of senior
leadership. By purchasing your dance bid and attending this event the student is acknowledging these rules and asserting
their consent.

Students who attend Fusion Academys Prom agree to the following:

Fusion Academy students and guests must check in no later than 7:30 pm. If you miss check in, your family will
be notified, and you will not be able to attend.
Fusion Academy students attending must be at least of high school age (grades 9-12).
Guests must be at least of high school age and no older than 21 years old.
All school rules apply.
Formal attire required. Do not wear anything too revealing. No jeans.
Student bags will be checked by Chelsea Piers Security upon entrance. Security has the right to deny student
admission to the venue as they see fit.
Any student or guest under the influence of or in possession of drugs and/or alcohol will be removed from the prom
and parents will be notified. Student will be subject to disciplinary action at their campus.
Smoking is strictly forbidden at the Sunset Terrace Room at Chelsea Piers. Those students caught smoking will be
asked to leave venue and be subject to fines incurred by venue.
Dancing must be tasteful. If dancing is not appropriate, a staff member will let you know. If it continues, you may be
removed from the dance floor.
Students will not chew gum, this is a venue policy.
Fusion students are responsible for the behavior of their guests, and should make sure that they are aware of all
prom policies.
All students must be picked up no later than 15 minutes after the prom has ended. Please make
sure to arrange transportation ahead of time.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

I have read the Fusion Academy Prom Policies and agree to the terms and conditions.

Student Name_________________________________ Student Signature____________________________________

Date___________

Parent Name: __________________________________ Parent Signature_____________________________________

Date___________ Parent Phone Number___________________________________________________

 Fusion Academy Guest Release Form

Attendance at Prom is a privilege and not a right. All students understand that Fusion Academy Administration reserves the
right to conduct appropriate searches, deny entry or remove students from this event at the sole discretion of senior
leadership. By purchasing your dance bid and attending this event the student is acknowledging these rules and asserting
their consent.

Students who attend Fusion Academys Prom agree to the following:

Fusion Academy students and guests must check in no later than 7:30 pm. If you miss check in, your family will
be notified, and you will not be able to attend.
Guests must be at least of high school age and no older than 21 years old.
All school rules apply.
Formal attire required. Do not wear anything too revealing. No jeans.
Student bags will be checked by Chelsea Piers Security upon entrance. Security has the right to deny student
admission to the venue as they see fit.
Any student or guest under the influence of or in possession of drugs and/or alcohol will be removed from the prom
and parents will be notified. Student will be subject to disciplinary action at their campus.
Smoking is strictly forbidden at the Sunset Terrace Room at Chelsea Piers. Those students caught smoking will be
asked to leave venue and be subject to fines incurred by venue.
Dancing must be tasteful. If dancing is not appropriate, a staff member will let you know. If it continues, you may be
removed from the dance floor.
Students will not chew gum, this is a venue policy.
Fusion students are responsible for the behavior of their guests, and should make sure that they are aware of all
prom policies.
All students must be picked up no later than 15 minutes after the prom has ended. Please make
sure to arrange transportation ahead of time.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------

I have read the Fusion Academy Prom Policies and agree to the terms and conditions.
Guest Name:
_________________________________________________________________________________________
Guests Home Address:
_________________________________________________________________________________
Guests Phone Number:
________________________________________________________________________________

Guest Signature: _______________________________________________________________

Date: __________________
Guests School Information
Name: _________________________________________________________________________________

Address: _______________________________________________________________________________

Phone: _________________________________________________________________________________

Guests Assistant Principals Name (print): ____________________________________________________________

Assistant Principals Signature: ______________________________________________________________________

**Must attach Assistant Principals Card

If guest is under the age of 18, guests parents must sign:

I have read the above statement and accept the conditions of my child attending this event.
Guest Parents Name:______________________________________________________________________________

Guests Parents Signature: ____________________________________________________ Date:__________________

Contact Phone Number: ____________________________________

I understand that I am responsible for my guests actions.

Fusion Academys Students Name (print):
_______________________________________________________________________
Fusion Academys Students Signature:
____________________________________________________________________

My son/daughter has my permission to take this guest to Fusion Academys Prom:

Fusion Students Parent Signature: ____________________________________________ Date: ___________________

Fusion Students Parent Phone Number:__________________________________________________________________