Parent / Guardian Consent Form
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64 Duffy Hall 400 South Orange Avenue South Orange, New Jersey 07079 Phone: 973-761-9172 Fax: 973-761-9482 |
Also available in PDF Form: Parent/Guardian Consent Form
Parent/Guardian Consent Form
Please print:
I, ________________________ , certify that I am the parent or legal guardian of
Parent/Guardian’s Name
__________________________ , who is ____ years old, and hereby give my consent
Guest’s Name
for him/her to visit _____________ ____ overnight at Seton Hall University, during the
Student’s Name
following days (please include dates):_____________________________________ .
During this overnight visit, my child will stay in a Seton Hall University residence hall.
By this document:
Ø I understand that my child may only stay a maximum of two (2) nights in a one (1) week period. I recognize that my child is responsible for his/her own actions while visiting Seton Hall University and staying overnight.
Ø I understand that my child’s visit is voluntary and that my child will be visiting and staying overnight at his/her own risk.
Ø I further understand that as a guest on Seton Hall University’s campus, s/he is required to abide by all policies and regulations as stated in the University’s publications and materials.
In consideration of Seton Hall University’s allowing my child to visit overnight, I hereby release and hold harmless Seton Hall University, its trustees, regents, officers, employees and agents against loss (including reasonable attorneys’ fees) from any and all claims or causes of action for all known and unknown, foreseen and unforeseen, bodily injuries, damages to property and consequences thereof which may be sustained by my child or by me arising out of, or in connection with, my child’s overnight visit. In addition, I agree to take full responsibility for any damage done to University property by my child during his/her stay at SHU.
If my child should suffer an injury or illness during his/her stay, I authorize the employees of Seton Hall University to treat him/her or to use their discretion to transport, or to have my child transported, to any medical facility and hereby give consent in my absence to have my child treated by Seton Hall University or at any medical facility and I take full responsibility for that action.
Name: _______________________________ Land Phone:__________________
Cell Phone:______________
Parent/Guardian
Address: ________________________________________________________________
________________________________________________________________
Parent/Guardian Signature: __________________________ Date: ____________

