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 for a weekend night you if you are Part Time Dorm.
Student Name
*
First Name
Last Name
Student Phone Number
*
-
Area Code
Phone Number
Parent Name
*
First Name
Last Name
Parent Email Address
*
example@example.com
Parent Phone Number
*
-
Area Code
Phone Number
Student is a:
*
Guest/Day Student
Part Time Dorm Student
Are you requesting to stay overnight in the dorm for one night or multiple nights in a row? (Please submit separate forms if requesting non-consecutive nights.) The Overnight Fee is $26/night plus meals.
*
One night
Multiple nights in a row
Date you are requesting to stay overnight in the dorm:
*
-
Month
-
Day
Year
Date
How many nights will you be staying in the dorm?
*
First day you are requesting to stay overnight in the dorm:
*
-
Month
-
Day
Year
Date
Last day you are requesting to stay overnight in the dorm:
*
-
Month
-
Day
Year
Date
Will you be eating meals in the cafeteria while staying on campus?
*
Yes
No
How many breakfast meals will you attend? (Breakfast is $5.00)
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:
Electronic Signature. By typing your name and submitting this form you are agreeing to pay the fees associated with staying in the LCBI Dorm overnight and eating in the cafeteria. These fees will be added to your monthly invoice.
*
Type your full name
Submit
Should be Empty: