Albion Overnight Visitor Information

Overnight Visitor Information

What date are you staying overnight?

First Name

Last Name

Birthdate

Biological/ Legal Sex

Female

Male

Gender Identity

Email Address

Cell Phone

Home Phone

Mailing Address

Country

Street

City

Region

Postal Code

High School (start typing to select from the drop down menu)

CEEB code

Are you doing your overnight with one of our varsity athletic teams?

Yes

No

What team are you staying with?

Please put the name of anyone who is also registered for your visit that you would like to be paired to room with for the night.

Emergency Contacts

Name of Parent/Guardian

Home Phone

Work Phone

Cell Phone

Second Contact Person

Mailing Address

Country

Street

City

Region

Postal Code

Home Phone

Work Phone

Cell Phone

Medical Information

I am 18 years of age or older

Yes

No

Your parent or legal guardian must fill out the remaining portions of this form.

I, student, authorize Albion College and any person with staff responsibility at Albion College to obtain emergency medical, dental, optical , or other emergency care.

I, parent, authorize Albion College and any person with staff responsibility at Albion College to obtain emergency medical, dental, optical , or other emergency care.

Authorizing Name by typing below

Release from Liability, Waiver of Right to Sue:
In consideration of my participation in this program, I release and discharge Albion College, each Albion College employee who conducts any activity in which I may take part, from any and all claims, demands, damages, rights of action or causes of action that might otherwise accrue to my child now and later.

By clicking here you are agreeing to the above release from liability

Agree

Authorizing Name by typing below

Release of Medical History, Health Insurance, and Contact Information:
It is my responsibility to provide any pertinent medical history information, health insurance carrier, and emergency contact information to Albion College prior to participation in this program.

By clicking here you are agreeing to the above terms

Agree

Authorizing Name by typing below

Name of Physician

Physician's Phone Number

Insurance Company

Insurance Company Phone Number

Insurance Contract Number

Insurance Group Number

Please list any medications, diet restrictions, or other accommodations needed.

I agree to abide by Albion College standards and expectations during my visit and understand that, in the case of an emergency, every attempt will be made to contact the listed parent or guardian prior to any medical treatment.

By clicking below you are agreeing to the above terms

Agree

Authorizing Name by typing below

Todays Date

I authorize Albion College Student Health Services staff, administrators, Office of Student Affairs staff, and Campus Safety Officers to arrange for ambulance or other emergency transportation and emergency-room treatment in case of serious or sudden injury, illness or other condition.

By clicking below you are agreeing to the above terms

Agree

Authorizing Name by typing below

*If possible the student should bring a copy of health insurance card/information with them during the visit.

Overnight Visit Policy and Contract

I understand that I am a guest of Albion College and as such, I assume full responsibility for my actions and behavior while on campus.

I understand that as a guest of the College, I am expected to abide by Michigan State Law and
Albion College Standards of Conduct regarding personal conduct, alcohol and I am aware that my behavior as an overnight guest of Albion College can be considered by the Admissions Office, and violations of this policy can impact my application for admission.

By clicking below you are agreeing to the above policy and contract

Agree

Additional Information/Requests

Authorizing Name by typing below