CHA Student Prom Registration

The Prom will take place on Saturday, April 28, 2018, from 7 p.m. to 10 p.m.

Theme: Country

Location:
Pumpkin Creek Farms
7392 Barclay Road
Sherman, IL 62684

Cost: $30

By filling out this registration form and putting your name down you are agreeing to the Guidelines/Dress Code/Code of Conduct and giving permission for your child to attend.


Student Name *
Student Name
Phone Number *
Phone Number
Phone number of non CHA student
Phone number of non CHA student
CHA student is in good standing with respect to grades, attendance, and school discipline? *
Photo Release *
*
Date *
Date
Date *
Date
In Case Emergency Phone Number *
In Case Emergency Phone Number