Underage Visit – Parental Permission

Guests may not be younger than 14, unless accompanied at all times by the parent/guardian. No guests under age 14 may stay overnight.

Forms are due to HRL:

Guests wanting to visit Tuesday, Wednesday, Thursday, or Friday must submit this form by 12 pm (noon) on the day prior to the visit
Guests wanting to visit Saturday, Sunday, or Monday must submit this form prior to 12 pm (noon) on the Friday preceding the visit.

Guests may be refused entry to the building if forms are not received by the deadline.

Host Information

Host First Name

Host Last Name

Host ID #

Host Phone Number

Host WCSU Email

Host Building

Host Room #

Guest Information

Guest First Name

Guest Last Name

Guest Phone Number

Guest Date of Birth

Guest Street Address

Guest City

Guest State

Guest Zip Code

Permission for

One time visitAll Semester visitation

One Time Visit Permission

Date Checking In

Date Checking Out

I give permission for

Print name of Visitor

to stay at Western Connecticut State University for an overnight visit as a sibling or underage guest on the dates mentioned above. I/we understand that the purpose of this request is to visit with a sibling or friend. I/we understand that as a visitor to the campus, this person is bound by the same rules and regulations as a University student, along with the same penalties for a disregard of the rules. I understand that I will receive a call from university staff to confirm my permission prior to this visit at the contact numbers listed above. My/our signature(s) below indicates my acceptance of these terms.

Semester-Long Visititation Permission

I give permission for

Print name of Visitor

Semester

Fall/Spring/Yr

to stay at Western Connecticut State University as a guest of the host student named below, periodically over the entire semester. I/we understand that the purpose of this request is to visit with a sibling or friend. I/we understand that as a visitor to the campus, this person is bound by the same rules and regulations as a University student, along with the same penalties for a disregard of the rules. I/we further understand that this permission may be revoked at any time by my email to housing@wcsu.edu. My/our signature(s) below indicates my/our acceptance of these terms.

Parent/Guardian Contact Information

Entering your information here serves as your signature of permission for the visitation requested.

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian Phone Number

Relationship

Would you like the Parent/Guardian info above to act as an Emergency Contact?

YesNo

Alternate Emergency Contact Information

Alt. Emergency Contact First Name

Alt. Emergency Contact Last Name

Alt. Emergency Contact Phone Number

Relationship

Would you like to add another Emergency Contact?

YesNo

Would you like to add another Emergency Contact?

YesNo

Second Emergency Contact Information

Sec. Emergency Contact First Name

Sec. Emergency Contact Last Name

Sec. Emergency Contact Phone Number

Relationship