Request to Shadow

Request to Shadow
Student Information *

First Name Last Name
Student's Current School *
Student's Current Grade *
Medical or Health Conditions: Does your student have any medical or health conditions that we should be aware of? If so, please specify. If not, type no. *
Does your student receive any type of Special Education Services? *
If yes, please explain
Student's Gender *
Parent Information *

First Name Last Name
Parent Email *
example@example.com
Parent Cell Phone *
Please enter a valid phone number.
What activities interest your student?
Please check all that apply:

Bible English Science Math History Computer Foreign Language Theater Choir Orchestra Band Visual Art Video Production Cross Country Track & Field Baseball Soccer Basketball Girls Volleyball Cheerleading
How did you hear about Christian Liberty Academy? *
What families or students do you know who attend Christian Liberty Academy? (optional)
Is there anything else you would like us to know before your student's visit? (optional)
Schedule your shadow day (Monday-Friday) *

Month Day Year
Date
Emergency Permission: In the event, the parents/guardians listed above cannot be reached in an emergency, I/we hereby give a school official permission to take my/our child to the nearest hospital for treatment while attempting to reach parents/guardians. I/we agree to hold such person and Wheaton Academy “harmless and free of any legal responsibility” of any claims, demands, or suit for damages arising from this action. (required)*
Emergency Permission: please sign below *
I give my child permission to attend Christian Liberty Academy on the above date. I understand that Christian Liberty Academy will only allow students who are considering attending CLA next year to visit. My signature further absolves the school of any liability concerning my child while he/she is on the school premises. I also understand that my child must comply with CLA's code of dress and conduct, or be asked to leave.
Parent Signature
Should be Empty: