Student Shadowing

2nd-12th Grade Students are able to shadow from September 12th - May 12th.

The First Academy allows students to shadow another student with similar interest in order to see what the life of a TFA student is all about. Please fill out the form below if you would like for your student to receive this option.

Questions? Contact Nancy Chapin, Admissions Specialist, at 407.206.8836.
If you have not received a callback from Admissions within 1 business day please call 407.206.8836.

Student Information
Date you wish student to shadow*
Student's Current Grade*
Student's First Name*
Middle
Last Name*
Date of Birth*
Current School*
Upload a Recent Picture of Student:
Accepted file types: jpg, gif, pdf, tif, png, .
Parent/Guardian Information
Parent/Guardian's First Name (1)*
Middle
Last Name*
Parent/Guardian's First Name (2)
Middle
Last Name
Parent's Cell*
Parent's Email*
Are you interested in enrolling your student for the CURRENT school year?*
- Yes
- No
Student's Interest
Is your student interested in sports? If yes, which ones?*
Student's Favorite Activities
Other Comments
Physician Information
Physician
Physician's Phone
Physician's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Dentist Information
Dentist
Dentist's Phone
Dentist's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Insurance Information
Insurance Company
Insurance Policy Number
Group
Insurance Preferred Hospital
(Responding medical unit will make final determination as to the appropriate facility for the injury.)
Medical Conditions*
Explain, in detail, any health considerations that may affect this child while at school (i.e., chronic conditions, previous surgeries, none, etc).
Prescription Medications (None? Please indicate so)*
Please note: School based emergency medications do not leave the school for field trips or after school activities. The parents have the responsibility of making arrangements with his/her child's teacher or after school personnel supervising your child in providing emergency medication, from home, for each field trip or after school activity.
Does this student have a history of Asthma?*
- Yes
- No
If yes, will an inhaler be needed at school?*
- Yes
- No
You answered 'Yes' to your student needing an inhaler at school. Please provide the school's clinic with a signed consent form.
The inhaler will be kept in*
Allergies (None? Please indicate so)*
(Please detail any important allergies including insect bites/stings, foods, etc.)
Does your child have an Ephinephrine Injection?*
- Yes
- No
You indicated your student has an Ephinephrine Injection, you must provide the school's clinic with a signed consent form from the lower school clinic.
Student Health Service Consent
Participate in the School Health Services Program?*
- Yes
- No
Consent given for my student to participate in the School Health Services Program. This means my student will receive emergency care in school, if needed, and health appraisals at school, including screenings such as vision, pediculosis, scoliosis, and hearing and growth development. I will notify the school of any changes of this information in writing and submit it to the clinic personnel.
Request Contact?*
- Yes
- No
Consent given in case of an accident or illness where treatment is not needed, but where my student is unable to remain at school, I request the school contact me. If I am unable to be reached, I request that one of the emergency contact persons listed in my Ren-Web Family Profile be contacted to care for my student until I can be reached. I will notify the school of any change of this information in writing and submit it to the clinic personnel.*
Contact via Ren Web?*
- Yes
- No
In the event of a serious accident or illness, I request the school contact me at the numbers listed in my Ren-Web Family Profile. If the school is unable to reach me, I hereby authorize the school (noted by my initials) to contact the physician or dentist indicated and to follow his/her instructions. If it is impossible to contact the physician or dentist or if no physician or dentist's name has been provided above, the school may make whatever arrangements are necessary to provide emergency care and treatment for my student. I will notify the school of any changes in writing and submit it to the clinic personnel.
Contact 911?*
- Yes
- No
In the event of a life threatening accident or illness, I understand that the school may contact the 911 emergency medical systems immediately. My selection indicates my agreement to be financially responsible for my student's care and treatment.
Immediate Treatment?*
- Yes
- No
In order to expedite care of my student, my selection hereby give my permission for the responding emergency team to immediately initiate treatment and transport of my student to the preferred or appropriate medical facility, according to what they deem is indicated by the nature or extent of the injuries. I agree to be financially responsible for my student's treatment and transport. I will notify the school of any changes in writing and submit it to the clinic personnel.
Agree to be financially responsible for?*
- Yes
- No
Consent authorizing any representative of the school, in whose care my student has been entrusted, to present my student to an approved medical treatment center, and do consent to an x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, to be rendered to my student under the general practitioner, surgeon or dentist licensed to practice in any state in the United States. I agree to be financially responsible for my student's treatment. I will notify the school of any changes in writing and submit it to the clinic personnel.
Name of Person Completing Form
First Last
Relationship to Student*
By submitting this form, I hereby agree that I am the legal parent or guardian of this student. I have completed the above medical information and have indicated my preferences for my student's treatment

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Student Information

Parent/Guardian Information

Physician Information

Dentist Information

Insurance Information

Student Health Service Consent

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