Campus Visit Permission

During their visit, prospective students will learn more about St. Agnes: tour the campus, visit classes in progress, enjoy a performance by our Band/Orchestra program and hear our acclaimed Triple Trio vocal ensemble perform. The visit concludes with a review of the admission process and time for questions with our students. Lunch will be provided.

*Student First Name

*Student Last Name

Student Street Address

City, State and Zip

Student Email

*Current School

*Parent 1 Name

*Parent 1 Email

*Parent 1 Cell Phone

Parent 2 Name

Parent 2 Email

Parent 2 Cell Phone

We (I) hereby release St. Agnes Academy and all its employees and agents from all claims on account of any injuries which may be sustained by our (or my) daughter while traveling to and from and visiting the St. Agnes campus, and its employees and agents (volunteers, students or bus drivers) for any claim which may be hereafter presented by our (or my) minor daughter.

Additionally, I authorize St. Agnes Academy or any of its employees to secure medical treatment for my daughter in the event of an emergency, accident or illness.

*Date

mm/dd/yyyy

By entering my name below, as an electronic signature, I agree to the terms listed and I am certifying that the information listed above is accurate and complete.

*Parent Signature

Please list the name and number of an emergency contact in the event that a parent cannot be reached during an emergency.

Emergency Contact Name

Emergency Contact Phone