St. Agnes Academy

Campus Visit Permission Form

During their visit, prospective students will learn more about St. Agnes: tour the campus, visit classes in progress, watch our Tigers Girls dance and hear our acclaimed Triple Trio vocal ensemble perform. The visit concludes with a review of the admission process and time for questions with our students.

Student Information

Student Name*

Student Address

City, State and Zip Code

Current School*

Parent Infomation

Parent 1 Name*

Email*

Parent 1 Cell Phone*

Parent 2 Name

Parent 2 Email

Parent 2 Cell Phone

Section

Student Name*

We (I) request that my daughter visit St. Agnes Academy with her eighth grade class. St. Agnes will provide bus transportation to and from both campuses.

We (I) hereby release St. Agnes Academy and all its employees and agents from all claims on account of any injuries which may be sustained by our (or my) daughter while traveling to and from and visiting the St. Agnes campus, and its employees and agents (volunteers, students or bus drivers) for any claim which may be hereafter presented by our (or my) minor daughter.

Additionally, I authorize St. Agnes Academy or any of its employees to secure medical treatment for my daughter in the event of an emergency, accident or illness.

List any physical conditions or ailments:

Date: (M/D/YYYY)*

Parent Name*

By selecting "I agree" below, I agree to the terms listed and I am certifying that the information listed above is accurate and complete.

I agree

Please list the name and number of an emergency contact in the event that a parent cannot be reached during an emergency.

Emergency Contact Name

Emergency Contact Phone

ST. AGNES ACADEMY
PURSUING LIVES OF TRUTH, PASSION, AND PURPOSE SINCE 1906

9000 BELLAIRE BLVD. HOUSTON, TX 77036
PHONE: 713.219.5400 FAX: 713.219.5499

CONTACT US