Middle School Dance Tickets

A separate form must be submitted for each student, but multiple tickets may be purchased at once.

* Indicates required field

Student Name *

First

Last

Name of Student's School *

*Any middle-school age students are welcome to attend, regardless of school affiliation.

Student Grade *

Parent Email *

Parent Phone on 11/12 *

Students attending the PCLC Middle School Dance must adhere to the conduct code.
CONDUCT:

All students will remain in the dance hall for the duration of the event, unless met by a parent at the door.
Students will refrain from any form of sensual physical contact during the dance.
Attendees agree to respect dance supervisors and fellow students.

Electronic Signature *

Student agrees to adhere to the above.

Submit

$25.00