The Cincinnati Homeschool Prom

Full Name

Address

Email Address

Phone Number

Age

Emergency Contact Name

Emergency Contact Number

All Proceeds from these events go to The Cincinnati Homeschool Prom.

Please list any dietary or health concerns

User Agreement

By continuing, you agree to release and hold harmless The Cincinnati Homeschool Prom, including chaperones from any cause
of action, claims, or demands now and in the future. I/we agree to follow the rules of the event holders and facility rules and take full responsibility for my/our behavior. I understand that The Cincinnati Homeschool Prom takes every precaution to ensure the safety of its guests. In the event that I/we should observe any unsafe conduct or conditions before, during or after my/our events I/we agree to report the unsafe conduct or conditions to the parents chaperoning and the event coordinator.

Please Choose One

I give permission for my photos to be used on social media
I do not want my photos used on social media

Please list any songs that you would like to hear.. (Lyrics must be CLEAN)