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SMITHVILLE HIGH SCHOOOL AFTER PROM 2018
This form and Power Play release need to be signed and returned.
Who can attend? All SHS Seniors and Juniors & their dates/guests (under the age of 21). Power Play release forms must be turned in to attend. Guest must have a completed guest permission slip and Power Play release form. When: May 5-6
th, from midnight to 4:00am (Students will need to drive directly home after)
Where: Northland Power Play , 509 NW Barry Road, Kansas City, MO Why: To have a FUN time with friends, eat lots of food, play all types of games, and WIN awesome PRIZES! Our goal is to maintain an alcohol and drug-free environment. Emergency contact number during After Prom: 816-419-0567
2018 GAME ON is a night full of all types of games for these kids. Unlimited arcade games, laser tag & maze, bumper cars, Go-karts
and many more! We will have lots of food, cash giveaways, game competitions and opportunity to win many PRIZES. And, the best
thing about the whole event………. 2018 SHS AFTER PROM IS FREE!
Students will not want to miss out on the fun! So, here’s the RULES:
1. Students must arrive at the northland Power Play between midnight and 1:30am. Students MUST have the Power Play Release
form turned in. Students will not be allowed to leave until 4:00 am, unless they have an early release form on file. All students and
guests will be asked to sign-in and out with a volunteer. Because of the driving curfew, all students are to drive directly home from
the Smithville After Prom event. Please encourage all students to do this!
2. Participants agree not to use alcohol, before, during, or after the event. Anyone violating this rule will be dealt with by the Kansas
City Police Department.
3. Abide by the rules and regulations of Power Play. Respect yourself and the rights of others.
4. Students will not be allowed to bring in any outside food or drink.
5. Power Play has restrooms for students to change. Prom clothing should be stored in their cars before checking-in.
6. Students do not have to attend PROM to attend AFTER PROM.
SHS After Prom t-shirts are available to purchase until April 20th
. After that date we will sell the extra t-shirts that we order until gone. Each shirt
costs $7.00. Send money to the SHS office with the student’s name, t-shirt size and cash/checks made payable to SHS After Prom. T-shirts will be given at After Prom.
I have read and understand the Rules and Codes of Conduct for the SHS After Prom Event, which will be held at midnight on May 5th until 4:00 am on May 6th. My
student and I agree to follow these rules. I permit the above named Student/Guest to attend this event. I understand that if my student wishes to leave the event
before the stated 4:00 am end time, they will not be allowed to re-enter the event, and I must be present to sign my student out in person if I agree to their leaving
the event before 4:00 am or designate another adult to do so (see below).
In consideration of the acceptance of my student’s entry in the SHS After Prom event I, the undersigned participant, intending to be legally bound, do hereby for
myself and heirs, executors, administrators and assigns, forever waive, release and discharge any and all rights, claims and actions for damages that I may have, or
that may hereafter accrue to me against the Smithville After Prom Committee and Smithville School District including all units and councils, and all of their officers,
directors, members and volunteers.
I attest and verify that my student is physically fit and able to participate in this event and acknowledge that I am aware of the inherent risks in participating in an
event of this type.
I understand that if my student does not check in at Smithville After Prom event, I will receive a phone call alerting me that they have not arrived at the event.
(Parent Name - PLEASE PRINT) (Parent Signature) (Date)
(Student Name - PLEASE PRINT) (Student Signature)
( ) ( ) Home Phone Parent Cell #
STUDENT GRADE: 12 11 10 9 NON-SHS GUEST OF: (SHS Student Name)
Guests are any students who do not attend Smithville High School, or are Freshmen or Sophomores
PARENT PERMISSION FOR DESIGNEE TO SIGN OUT STUDENT BEFORE 4:00AM We require that an adult Parent/Legal Guardian/Designee be present to sign out the student. If you would like to designate another Adult to sign out your
student, please indicate this person’s name and contact information below. My student has my permission to leave the SHS After Prom Event prior to 4:00 a.m. on
May 5-6, 2018. I further designate the following individual(s) to sign out my student and make sure they arrive safely to their final destination, in the event that I am
not present.
Name: (Contact phone number)
SMITHVILLE HIGH SCHOOOL AFTER PROM 2018
This form and Power Play release need to be signed and returned.
SMITHVILLE HIGH SCHOOOL AFTER PROM 2018
This form and Power Play release need to be signed and returned.
2018 SHS After Prom
Date: May 5-6, 2018, Midnight to 4:AM!
Theme: Game On
Location: Power Play North, 509 NW Barry Road, Kansas City, MO 64155
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We are excited to host our event this year at Power Play North. Students will enjoy a variety of arcade games, rides, food, and fun competitions. Every year at After Prom, students enjoy the coupons, merchandise, gift cards & certificates generous business owners and parents give.
Any donation amount or item is greatly appreciated and accepted. Donations will help cover the cost of food, games, prizes & entertainment. https://www.gofundme.com/shs-2018-after-prom
Thank you for your support of our young people and making this upcoming AFTER PROM a memorable event!
Sincerely, Erika Cutler-Deen, After Prom Coordinator * [email protected]
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After Prom T-shirt Logo Design
Please forward a print of this form and your student’s $7 along with name and t-shirt size to:
After Prom Student:
Smithville High School Seniors print on back: Yes or No 645 South Commercial Smithville, MO 64089 Black t-shirt Size:
