Dec 1 Placement Exam

Wednesday, December 1, 2021
8:00 AM 11:00 AM 08:00 11:00

Chesterton Academy N74W13646 Appleton Ave Menomonee Falls United States (map)

Google Calendar ICS

Freshmen and sophomores must complete an admissions application prior to the placement exam. Students in upper grades will be notified if they need to take it. The exam is from 8 - 11 a.m. at Chesterton Academy. Students should bring pencils and a snack. No calculators will be allowed for this test.

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

(###)

###

####

Email Address

Parent Name

Parent Phone

(###)

###

####

Email Address

Food Allergies

Prescription Medications

Test Day Emergency Contact Name

First Name

Last Name

Emergency Contact Primary Phone

(###)

###

####

Emergency Contact Alternate Phone

(###)

###

####

Emergency Contact Relationship

COVID-19 Waiver

COVID-19 * COVID-19 has been declared a worldwide pandemic and is extremely contagious. Even with implementation of safety protocols, Chesterton Academy cannot guarantee that you, members of your household, or your child(ren) will not become infected with COVID-19 and cannot guarantee that shadowing at Chesterton Academy and/or participation in Chesterton Academy’s activities will not increase your risk and/or your child(ren)'s risk of contracting COVID-19. By signing this COVID-19 Pandemic Waiver, I/we acknowledge the contagious nature of COVID-19, that my/our child(ren) and I/we may be exposed to or infected by COVID-19 by shadowing at the school and/or by participating in school activities, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I/we understand that the risk of becoming exposed to or infected by COVID-19 at the above-named School may result from the actions, omissions, or negligence of myself/ourselves and others, including, but not limited to School employees, volunteers, students, and their families. I/we further agree on behalf of myself/ourselves, my/our child (student) named herein, and my/our heirs, successors, and assigns, to absolutely release, defend, indemnify, and hold harmless the named School, associated parishes and school systems, principals, teachers, volunteers, and the Archdiocese of Milwaukee, its directors, officers, employees, attorneys, agents, representatives, and insurers/third-party administrators (hereinafter collectively referred to as the "Indemnified Parties") from any and all claims or causes of actions in any way related to COVID-19, brought by any person or entity, including but not limited to, all claims and causes of action based on the alleged negligence of the Indemnified Parties, other third parties, or my own negligence. By checking below, you signify this is to be used as your signature.

Yes

Posted in Admissions
Tagged Admissions