LCBI Guest/Part Time Dorm Overnight Request Form
Please use this form if you would like to stay in the LCBI Dorm as a guest, or if you are a part-time dorm student who wishes to stay for the weekend. The Overnight Fee is $26/night plus meals.
Student Name
*
First Name
Last Name
Student Phone Number
*
Format: (000) 000-0000.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Format: (000) 000-0000.
Student is a:
*
Guest/Day Student
Part Time Dorm Student
First Night of Stay
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Number of Nights:
*
Will you be eating meals in the cafeteria?
*
Yes
No
How many lunch meals will you attend? (Lunch is $9.00)
How many supper meals will you attend? (Supper is $9.00)
Comments or additional information:
(example: allergies the kitchen is not aware of)
Electronic Signature: By typing your name and submitting this form, you agree to pay all applicable fees associated with your students overnight stay in the LCBI dormitory and, if applicable, meals in the cafeteria. These fees will be added to your monthly invoice.
*
Parent/Guardian Full Name
Submit
Should be Empty: