Shadow Days

Student Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Current Grade*

8th Grade
7th Grade

Phone*

Gender*

Female
Male

Current School*

City/Town of School*

Where did you hear about Providence Catholic Shadow Days?*

Website
Friends
Social Media
Radio
School/Church

T-Shirt Size (Adult Sizes)*

Shadow Day Specifics

I request to attend a Shadow Day visit on the following date:*

Please list either a particular student’s name that you would like to shadow or if you want a student sharing a specific interest (i.e. a member of the Dance team, a choir member). We will do our best to accommodate if possible.

Select up to FIVE activities that you are interested in*

Parent/Guardian Completing This Form

Name*

First Last

Maiden Name (If Applicable)

Phone*

Email*

Are you a PCHS Graduate?*

Yes
No

PCHS Class of

Medical/Emergency Information

Please list any medical issues (eg. allergies, diabetic, etc.) or other issues that we should know about:

Medical Issues*

Emergency Contact Information

Please list an additional person to contact in case of an emergency

Name*

First Last

Phone*

Relationship to student*

Parent /Guardian Permission

In order for your child to attend a Shadow Day visit at Providence Catholic High School, a parent/guardian must READ and AGREE to all of the following statements. I am the parent/guardian of the child listed above and give permission for my child to attend a Shadow Day visit at Providence Catholic High School (PCHS). I authorize PCHS employees to give normal first aid to my child and understand that PCHS is not to be held liable for the bestowal of such health care. I hereby release PCHS and all its employees from liability and harm arising to my child during this visit to the school. In the event that I cannot be contacted, I hereby give my permission for any necessary emergency treatment that is administered for the welfare of my child.

Permission*

Yes, I have read and agree

Media Release

Please note that photos may be taken during shadow day and used for social media or marketing purposes.

Agree to the message shown

Phone

This field is for validation purposes and should be left unchanged.

Shadow Day registration is open for 7th & 8th graders!

Shadow Day Schedule

Shadow Day

Student Information

Shadow Day Specifics

Parent/Guardian Completing This Form

Medical/Emergency Information

Emergency Contact Information

Parent /Guardian Permission

Media Release

Calendars

Future Students

Current Students

Parents

Alumni

Faculty & Staff

Shadow Day registration is open for 7th & 8th graders!

Shadow Day Schedule

Shadow Day

Student Information

Shadow Day Specifics

Parent/Guardian Completing This Form

Medical/Emergency Information

Emergency Contact Information

Parent /Guardian Permission

Media Release

Calendars