Shadow Day

Monday, October 21, 2019
8:10 AM 3:25 PM

Chesterton Academy of Milwaukee 9000 W Chester St, #310 Milwaukee, WI 53214 (map)

Google Calendar ICS

Shadow Day - This is a great opportunity for prospective students to experience Chesterton Academy first hand. Register below. You must also print and return a completed Medical Information Form. If your student has allergies, you need to complete and return an Allergy Action Plan form.

Student Name

First Name

Last Name

Birthdate

YYYY

Current Grade

Current School

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name

First Name

Last Name

Parent Phone

(###)

###

####

Parent Email Address

Parent Name

First Name

Last Name

Parent Phone

(###)

###

####

Parent Email

Shadow Day Emergency Contact

First Name

Last Name

Relationship

Phone Number

(###)

###

####

Emergency Contact 2 Name

First Name

Last Name

Relationship

Phone Number

(###)

###

####

Photography Release

I consent to any still or electronic image, audio and/or video recording, in which my child or family members may appear during the shadow day, for potential promotional purposes of Chesterton Academy of Milwaukee.

Yes

Transportation

In the interest of safety and security, all shadow students will be either transported by school bus or driven by their parent or other driver assigned by the parent/guardian for the ride between the local Mass location and school. My student has permission to ride between the local Mass location and Chesterton Academy of Milwaukee with Chesterton Academy of Milwaukee’s contracted school bus. I, as a parent or guardian of the above named student, agree to hold Chesterton Academy of Milwaukee harmless for any and all damages, injuries, loss of life, or other losses that my child may sustain or incur, if any, while participating in any school-related activities, including offsite Mass and transportation between off-site locations and the school. I assume full risk, waive all claims and hold Chesterton Academy of Milwaukee, its staff, instructors, board members and volunteers harmless of any and all claims related to my child’s visit day with Chesterton Academy of Milwaukee on the above scheduled date or an alternate date, if this visit day is rescheduled or repeated on another day.

I agree.

I do not agree.

Medical

By checking the box below, I agree to keep Chesterton Academy of Milwaukee informed of my emergency contact information and any special medical needs and/or conditions my child may have. If my child has an inhaler, Epi-pen, or other emergency medication potentially needed for any condition, I agree that it is my child's responsibility to keep this medication, and a copy of his or her Allergy/Asthma Action Plan, with him or her at all times during off-site activities or field trips. A copy of the Allergy/Asthma Action Plan will be kept in the school office as well. This form is available here or through the office. Further, I authorize Chesterton Academy of Milwaukee's staff, instructors, board members, and volunteers to seek and provide emergency medical care in the event of an injury, illness, allergic reaction or other emergency.

Yes

Posted In: Admissions, Public Event
Tagged: #Catholic, #CatholicHighSchool

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