Please use this form to submit your information to Ms. Reisman for a Shadow Day.
Student cell phone number
Please list the participant's cell phone number below if you consent to receiving occasional text messages from Saint Ursula Academy.
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Home Phone Number
Parent Email Address
Parent Cell Phone Number
Desired Shadow Date
Please note that if the date you would like is not listed below, it is not available for a Shadow Day.
Monday, December 14
Tuesday, December 15
Thursday, January 7
Friday, January 8
Monday, January 11
Tuesday, January 12
We will be providing personal pizzas for lunch. Please indicate the type of crust you prefer.
Gluten Free Crust
A box lunch will be provided based on your dietary preference. Please choose one of the below options.
Gluten Free Lunch
Permission and Release of Legal Guardian on Behalf of Minor
The undersigned, on behalf of the minor listed above and for whom the undersigned is the natural or legal guardian, hereby releases Saint Ursula Academy, its trustees, officers, administrators employees and agents, from any and all liability of whatever nature relating to or in any manner arising out of the use by such minor of the Saint Ursula Academy’s program(s) and/or facilities. Furthermore, the undersigned agrees to indemnify and hold harmless Saint Ursula Academy, its trustees, officers, administrators, employees and agents, from any and all damages, expenses or other losses arising from or in connection with any suit, or other legal proceedings or otherwise, including attorneys’ fees with respect to the use of Saint Ursula Academy’s program(s) and/or facilities or any part of them by the minor named above. This release and indemnification shall be binding upon the personal representatives, heirs and assigns of the undersigned and of the minor named above. By registering for a shadow day, you hereby consent for your child to participate in a Shadow Day Visit which is a sanctioned activity of Saint Ursula Academy and authorize the staff of Saint Ursula Academy to act for you according to their best judgment in any emergency requiring medical attention, and you hereby waive and release Saint Ursula Academy from any and all liability for any injuries or illnesses incurred while at Saint Ursula Academy. There is no knowledge of any physical impairment that would be affected by the named student’s participation in this activity. I also hereby agree that St. Ursula Academy and its agents may use a photograph, video, or other likeness of the minor listed above to be displayed and produced, electronically or in print, by Saint Ursula Academy or its agents. If I do not want Saint Ursula Academy to use the minor’s photograph for promotional purposes, I will notify the Admissions Department electronically at email@example.com prior to the start of the event requesting that the minor not be photographed during the event. I acknowledge that I have full power of authority to sign this document on behalf of the above minor, that I have read the foregoing paragraph, that I understand it, and that I have the option to have it reviewed by legal counsel prior to signing, and that I freely execute this document on behalf of the above minor.
Are you having difficulty signing above?
By initialling in the box below, I consent to the terms detailed in the "Permission and Release of Legal Guardian on Behalf of Minor" statement listed above.*
Name included in signature/initials above
Date Format: MM slash DD slash YYYY
Name of desired SUA student to welcome you on your shadow day:
Your requested SUA student will be looking forward to welcoming you! Whenever possible, you will attend class with your requested hostess, however, due to COVID -19 safety protocols which include classroom spacing/capacity limitations, your daughter may have the opportunity to attend a class that is different from your requested hostess.
Interests and Hobbies
In order to pair you with an Ambassador, please list a few of your interests and hobbies. We will do our best to make sure you are with a hostess who shares a similar interest!
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