Guest Authorization Form – Minors

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Resident students wishing to host a guest(s) under the age of 18, who are not accompanied by a parent or legal guardian, may do so only with the prior consent of the parent or legal guardian and subject to the approval of the Area Director of Student Housing. This form must be completely and properly filled-out for your request to receive consideration.

TO BE COMPLETED BY MINOR’S PARENT OR LEGAL GUARDIAN ONLY

Waiver to Be Completed by Minor’s Parent or Legal Guardian: In consideration of being permitted to visit or participate in any activities on the University campus the below-named minor and I assume all risk and responsibilities during the visit of the named minor guest. I, for myself, my heirs, personal representatives or designees, do hereby release, waive, discharge, and covenant not to sue Regent University, its trustees, officers, employees, and agents from liability for any and all claims including the negligence of Regent University, its trustees, officers, employees, and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from but not limited to, visitation or participation in any way while the minor is visiting the University. I understand Regent University expects that all guests will abide by all University policies as well as all local, State, and Federal laws. I have reviewed behavioral and conduct expectations with my minor. Further, I understand that Regent University assumes no supervisory responsibilities for my minor during the visitation period. It is also understood that visitation privileges may be revoked at any due to identified violations of campus and residence hall behavioral expectations.

I certify that I understand the above statement and that I am the parent or legal guardian of the named minor listed below who is under 18 years of age, and that I give my consent for this individual to visit Regent University residence halls, under the supervision of the below student resident host during dates listed below.

Name of Minor(Required)

First Last

D.O.B.(Required)

Name of Parent/Legal Guardian(Required)

First Last

Email Address of Parent/Legal Guardian(Required)

Signature of Parent/Legal Guardian(Required)

Date(Required)

Home Address(Required)

Street Address City State ZIP Code

Cell Phone Number(Required)

Emergency Number(Required)

Resident Host Information

Student Host(Required)

First Last

Host's Phone(Required)

Host Building & Room(Required)

Requested Start Date of Visit(Required)

Requested End Date of Visit(Required)

This field is for validation purposes and should be left unchanged.