Shadow Day Registration

I would like to schedule a Shadow Day in the
Student's Name Student's Name First Last
Student's Address Student's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Current Grade
Current School
Current School City/State
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Email

A confirmation will be sent to this e-mail address.
Parent/Guardian Relationship to Student
Phone Number Phone Number - ### - ### ####
Proposed Date of your Visit:

Please select two dates on Tuesdays or Thursdays which would fit into your schedule. The date will be tentative until confirmed by the Admissions office.
Proposed Date of your Visit:

Please select Mondays which would fit into your schedule. The date will be tentative until confirmed by the Admissions office.
Potential Date #1 Potential Date #1 / MM / DD YYYY
Potential Date #2 Potential Date #2 / MM / DD YYYY