Parental Consent Form-(for Minors)

Parental Consent Form-(for Minors)

Office of Residence Life- Southern Connecticut State University
Guests ages 16-17 who intend to spend the night in the residence hall must have parental permission to do so. Please submit this form at least 24 hours prior to the minor guest's overnight visit. All guests are expected to abide by the guest policy and guidelines of the Guide to Living on Campus.
Guest Full Name*

First NameLast Name
Age*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian email*
example@example.com
Name of Student Residing on Campus:*

First NameLast Name
Residence Hall*
Please be aware guests under the age of 18 are only permitted to spend 1 night in the residence halls per visit.
Arrival Date*

MonthDayYear
Date
I, {parentguardianName}, give my child, {guestFull}, permission to sign into the residence halls of Southern Connecticut State University as a guest of SCSU student {nameOf} residing in {residenceHall} on {arrivalDate} through {departureDate}.

I agree to indemnify, defend and hold Southern Connecticut State University, it's officers, employees and agents, harmless from any and all costs, losses, expenses, damages, claims, suits, or any liability whatsoever, including attorney's fees, resulting from injury, including death, to a person or damage to property arising out of or, in any manner connected with, my child being supervised by the above named student in the residence halls of Southern Connecticut State University.
Signature*

Clear
Primary Emergency Contact Phone Number for Parent/ Guardian*
Please enter a valid phone number.
Secondary Emergency Contact Phone Number for Parent/ Guardian*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Parental Consent Form-(for Minors)

Please be aware guests under the age of 18 are only permitted to spend 1 night in the residence halls per visit.