Shadow Permission Form

We look forward to your child's upcoming visit to Gerstell Academy! As part of a typical school day, your child may participate in activities such as physical education. Please complete the information below and submit to the Admissions Office, along with a completed application required for a shadow visit.

*Applicant's First Name

*Applicant's Last Name

*Grade Applying For

*Please list any physical limitation or medical condition (including allergies and medications) that you would like us to be aware of. If none, please state 'none'

Emergency Information: In the event of a medical emergency involving this student, I hereby authorize Gerstell Academy to take necessary measures to have this student treated. It is understood that treatment will be done only after all reasonable efforts have been made to contact this student's physician and parent/legal guardian.

*In case of emergency, please notify

*Best Contact Phone #

*Email Address

*Electronic Signature of Parent/Guardian

*Date