Wabash Overnight Consent Form

Wabash College is pleased to welcome prospective students to campus for overnight visits. In order to ensure the best possible experience for our guests as well as our current students, the College requires that visiting students abide by Wabash College's single rule of conduct: The student is expected to conduct himself at all times, both on and off-campus, as a gentleman and a responsible citizen as well as the code of conduct enforced by the student's current institution. If you have questions about the Gentleman's Rule, you may ask an Admissions Staff member. The College may require a visitor to leave campus if he does not comply with this conduct requirement.

In the case of an emergency, I understand that reasonable efforts will be made to contact the parent/guardian or alternate contact listed below. If those efforts do not succeed, we hereby authorize the College to provide to the student, through medical personnel of its choice, customary medical assistance, transportation, and emergency medical services should the student require such assistance, transportation, or services as a result of injury or damage while on campus. This consent does not impose a duty upon the College to provide assistance, transportation, or services.

Please complete all fields in the form below:

Sex *

Wabash College, a college for men in the state of Indiana, while exempted from Subpart C of Title IX regulation with respect to its admissions and recruitment activities, admits male students and gives equal access to its scholarships, programs, and facilities without regard to race, color, sexual orientation, national or ethnic origin, or physical or other disabilities.

Email Address

First Name

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Emergency Contact Information:

Parent/Guardian First Name

Parent/Guardian Last Name

Preferred Phone

Other Emergency Contact Name

Other Emergency Contact Phone

Name of Primary Care Physician

Physician Phone

Please list any allergies, illnesses, or physical conditions of which we need to be aware of

Please list any medications you are currently taking:

Please sign this document electronically below:

By submitting this form, you agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement.

Please type your signature below