Overnight Visit Policy for Ursinus College

This form is required for all visiting students. Please complete this form and submit at least 5 days prior to your visit.  You will not be permitted to stay overnight unless we receive this completed form.

Please read the following statement and sign your name to indicate that you understand the statement. Ursinus College requires that, as a guest, you assume the same responsibility for your actions that Ursinus students have assumed.  If you do not understand the statement or how it applies to you, please ask a member of the Ursinus College staff to explain it to you before you complete this form.

I understand that I am visiting Ursinus College on a voluntary basis, and I am responsible for my actions while on campus. I agree that :

-      Participants in on-campus visitation programs are required to abide by the Ursinus Student Code of Conduct and Pennsylvania state law.

-      Pennsylvania state law prohibits the purchase, possession, or consumption of liquor or malt or brewed beverages by those under the age of 21.

-       Negative behavior during my campus stay may result in immediate revocation of visitation privileges and will be evaluated by the Office of Admission for application and scholarship decisions.

For Parents and Guardians:

I give permission for my student named below to visit Ursinus College. I hereby indemnify and hold harmless Ursinus College, its agents and employees including board of trustees, directors, and officers. I release and give up all claims, including claims of negligence I may have in the future against the Party Released that arises out of my student’s participation in this activity.

In case of emergency and if I cannot be reached, I the undersigned parent or guardian of the below named student, do hereby authorize a representative of Ursinus College to consent to any medical treatment or care deemed advisable.

*Student First Name                   Middle Name                      *Last Name          
         

*Date of birth :    

Home address : 

*Street :  *City :

*State :   *Postal Code :

*Email address :        

*Cell Phone Number :

*High School :           

List special medical problems, allergies to medications, etc. :

*Name of Parent or Guardian:

Parent Home Address : 

*Street :  *City :  

*State :   *Postal Code :

Business Address :

Street :  City :  

State :   Postal Code :

*Daytime Phone Number :

*Evening Phone Number :

*Date of Overnight Visit :  pick date

Anticipated Arrival Time : 


If Athletics visit that was previously arranged by coach:

Team Visiting :   

Head Coach :      


Student Host (if Known) : 

*

*Student Signature :(please enter email address)

*Parent Signature :(please enter email address)

* Indicates required field