SCSU Sibling Event Parental Consent

Please complete this and all registration forms by

10:00 pm, Monday, September 29, 2025.

Event Time: Friday, October 3rd, from 6:00 pm to 9:00 pm in the Residence Life Quad behind Farnham Hall.

Siblings of commuter students and siblings of residents 5-7 years old should be picked up by 9:00 p.m. at the conclusion of the event on Friday, October 3rd.

Siblings of residents ages 8 to 15 are permitted to stay the night in their SCSU sibling’s residence hall until 10:00 a.m. on Saturday, October 4th, 2025 with roommate and parental consent. (Siblings not participating in Family Day on October 4th must be picked up by 10:00 a.m. at their student's residence hall.)

Last Name of SCSU Student

First Name of SCSU Student

SCSU Student ID Number

Student status*

CommuterResident on campus

Is the sibling(s) staying overnight in the residence hall with the SCSU Student?

Yes, sibling is staying overnight in the residence hall.No, sibling is leaving at the end of the event at 9pm.

Student's Residence Hall

Student's Room Number

Sibling Day Events:

Siblings age 5-15 are invited to attend activites on campus in the residence life quad on Friday, October 3rd from 6-9pm. Please submit this form by 10:00 am on Tuesday, September 30th. All guests are expected to abide by the guest policy and guidelines of the Guide to Living on Campus.

Sibling Day and Overnight Events:

Siblings ages 8-15 who intend to spend the night in the residence hall must have parental permission to do so. Please submit this form by 10:00 am on Tuesday, September 30th. All guests are expected to abide by the guest policy and guidelines of the Guide to Living on Campus.

Sibling Full Name*

First NameLast Name

Sibling's Age*

Sibling Full Name (2)

First NameLast Name

Sibling's Age (2)

Sibling's Parent/Guardian Name*

First NameLast Name

Parent Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Sibling's Parent/Guardian email*

example@example.com

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.

Please be aware siblings are permitted to spend the one night- Friday, October 3rd in the residence hall and must check out by 10am on Saturday morning.

Photo and Video Release:

I hereby grant Southern Connecticut State University the irrevocable right and permission to use photographs and/or video recordings of me on university websites and other related university social media accounts in publications, promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me.
I understand and agree that such photographs and/or video recordings of me may be placed on the Internet. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all plates, negatives, recording tape, and digital files are and shall remain the property of the University.
I hereby release, acquit, and forever discharge the State of Connecticut, the University, its current and former trustees, agents, officers, and employees of the above-named entities from any and all claims, demands, rights, promises, damages, and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.
This release is binding on me and my heirs, assigns, and personal representatives. I have read and understand this document. I understand and agree that it is binding on me, my child (named above), our heirs, assigns, and personal representatives. I acknowledge that I am eighteen (18) years old or older and that I am the parent or guardian of the child named above.

Assumption of Risk:

In consideration of being permitted to participate in the sibling night event (hereinafter called " ACTIVITY") I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Southern Connecticut State University and/or the Board of Regents of Connecticut State Community Colleges and Universities (hereafter called “the University”), their trustees, officers, employees, and agents and to indemnify them from liability for any and all claims resulting from personal injury, accidents or illnesses (including death), and property damage or destruction arising from, but not limited to, participation in the Activity.

I understand that participation in the Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises and sprains, 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks and concussions, to 3) catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in the Activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
I also agree to indemnify and hold the University harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, brought as a result of my involvement in the Activity and to reimburse them for any such expenses incurred.

I further expressly agree that the foregoing waiver and assumption of risk agreement is intended to be as broad and inclusive as is permitted by the law of the State of Connecticut and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Finally, I have read this waiver of liability, assumption of risk and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend it by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Sibling Overnight Agreement:
I, {siblingsParentguardian}, give my child(ren), {siblingFull}, {siblingFull27} permission to sign into the residence halls of Southern Connecticut State University as a guest of SCSU student {nameOf} residing in {residenceHall} on Friday, October 3rd through Saturday, October 4th.

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. Last Name p>

Sibling Night Event Agreement:
I, {siblingsParentguardian}, give my child(ren), {siblingFull}, {siblingFull27} permission to attend the Sibling Night at Southern Connecticut State University as a guest of SCSU student {nameOf} on Friday, October 3rd from 6-9pm.

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*