2021 Shadow Day Registration

Please complete the form below. Required fields marked with an asterisk *

Email*

Answer Required

Students First / Last Name*

Answer Required

Current Grade School*

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Home Address / City / State / Zip*

Answer Required

Extracurricular Activities*

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Parent/Guardian First & Last Name*

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Parent/Guardian Phone Number*

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Please list 2 subject areas your daughter must interested in.*

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English

Fine Arts

Mathematics

Physical Science

Science

Social Studies

Theology

World Languages

Please list below, any relatives who are Regina Dominican alumnae:

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Please name a current Regina student you wish to be your daughter's guide, or leave blank and a student guide will be provided for you.

Answer Required

Allergies or Medical Conditions*

Answer Required

I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my daughter may be exposed to or infected by COVID-19 by attending the a shadow day and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I hereby release, covenant not to sue, discharge, and hold harmless Regina Dominican, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.*

Answer Required

Yes, I agree to the terms above and allow my daughter to attend a campus visit at Regina Dominican.

No, I do not agree to the terms above. By checking this box I am aware that my daughter will not be able to attend a shadow day at Regina Dominican.

Please fix the highlighted areas below before submitting.

2021 Shadow Day Registration