The Cincinnati Homeschool Prom

Mr.
Miss

First Name of Prom Guest:

Last Name of Prom Guest:

Please add the names of any additional Prom guests that you are purchasing tickets for:

*** Please include their homeschooling status and let us know if they are a Senior...:o)

Email Address:

Address:

City:

State:

Zip Code:

Phone Number:

Homeschool Status:

I am Homeschooled
I am a Guest of a Homeschooler
I am a Private School Student
I am a Virtual School Student
Other

Explain Other

If you are a Guest of someone please tell us who :

Emergency Contact Name:

Emergency Contact Number:

Relationship to you:

Tickets Desired

Prom $65.00 (Single Ticket)
Prom $125.00 (Couples Tickets)
After Prom $30.00 Single Ticket
Large Group Purchase

If you are purchasing multiple tickets please fill in the exact amount of each desired.

Payment Options:

PayPal
Personal Check or Money Order Mailed
Chase Quick Pay
Venmo

Please let us know if you are wth a certain group. This helps up keep all of the teens sitting close together.

Choose One

Leaves of Learning
Grace Academy
Privately Homeschooled at Home
ECHO
Other Co-op

Name of other co-op or group

Please let us know if you have any special dietary or medical concerns.