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Personal Visit Day Request
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* Indicates required question
Student's first name
*
Your answer
Student's last name
*
Your answer
Student's email address
Your answer
Who is attending Visit Day?
*
Please check the box that applies.
Student Only
Student & Parent(s)
Required
Is the student male or female?
*
Male
Female
Required
Current grade
*
Please indicate the grade the student is in this school year.
8th
9th
10th
11th
Other:
Current school
*
Please check the box by the current school your student attends.
Clear Creek Amana
Heritage Christian School
Hillside Christian School
Home School
Iowa City Community Schools
Lutheran Interparish School
Mid-Prairie Community Schools
Pathway Christian School
WACO
Washington Community Schools
Williamsburg Community Schools
Other:
Date you would like to visit
*
MM
/
DD
/
YYYY
Parent's first name
*
Your answer
Parent's last name
*
Your answer
Home address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Parent's email address
*
Your answer
Home phone number:
*
Your answer
Emergency contact number
*
In case we need to contact a parent on Visit Day due to an emergency.
Your answer
Family's current church
*
Please fill in the church you currently attend or "none" if you aren't currently attending a church.
Your answer
Please check areas your child is interested in.
*
Check all that apply
Art
Agriculture
Building
Drama
Foreign Language
History
Literature/Reading
Math
Music
Science
Social studies
Sports
Student government
Technology
Other:
Required
How did you hear about our school?
*
Website
Postcard
Radio ad
Friends or family
Other:
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