2024 8th Grade Day Registration Form

We are delighted to have your student as our guest on Friday, October 25, 2024!

Your child will have the opportunity to experience life as a Raider with a fun day lead by our CCHS students! Parent are also invited to attend and will have their own itinerary and workshops.

The day will start at 9:00am in the Mark Gallo Health and Fitness Center and end at about 1:15pm.

As with our own students, our number one concern is your student's health and safety while under our care. While we never expect an emergency to arise, it is important for us to have the following information to allow us to respond to situations appropriately and promptly or to contact you, if necessary.

Student's Name*

First NameLast Name

Email*

example@example.com

Gender*

FemaleMale

Current School*

Please state your child's current school*

Parent/Guardian #1*

First NameLast Name

Parent/Guardian #1 Cell Phone*

Please enter a valid phone number.

Parent/Guardian #2*

First NameLast Name

Parent/Guardian #2 Cell Phone*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Will either parent/guardian be attending the 8th grade day parents session?*

YesNo

If parent/guardian #1 and #2 cannot be contacted, please provide emergency contact below.

Emergency Contact's Name*

Emergency Contact's Phone Number*

Please enter a valid phone number.

Doctor's Name*

Doctor's Phone Number*

Please enter a valid phone number.

Health Insurance Provider*

Health Insurance Policy Number*

Does your student have any health concerns or dietary restrictions? Please list below.

Parent/Guardian Signature *

By typing my name, I release Central Catholic High School and its employees and will hold them harmless from any liability which may arise from incidents or accidents involving my student and me while on Central Catholic High School's premises, to the extent allowed by law.