Skip to content

Parent/Guardian Acknowledgement, Consent, and Release Form

I certify and agree that my child (named above) has my permission to participate in the Overnight Visit Program (the “Program”) at Washington University in St. Louis (the “University”), arranged by the Office of Undergraduate Admissions. I understand the nature of the Program and that University staff and student volunteers will not supervise or “chaperone” my child during the Program visit. I understand that my child is a visitor to the University and is expected to exercise good judgment and act in a respectful, responsible manner when choosing whether to participate in the many educational, recreational and social activities that are available. I understand that my child will be fully responsible for his/her conduct during the Program visit, is expected to follow University policies and all federal, state, and local laws, and is subject to the Overnight Rules & Expectations, which my child is required to sign and return. I understand that my child’s failure to do so may result in immediate dismissal from the Program, denial or withdrawal of any offer of admission, disciplinary action, and high school notification. I understand that the Office of Undergraduate Admissions will arrange for my child to stay in a single room in the Charles F. Knight Center hotel on the WashU campus.

In consideration for my child’s participation and on behalf of myself, my child, and my family, heirs, and personal representative(s), I agree to assume all the risks and responsibilities surrounding my child’s participation in the Program and, in advance, release, waive, forever discharge, indemnify, and hold harmless and covenant not to sue the University, its governing board, directors and officers, agents and employees (collectively, “Releasees”), from and against any and all liability for any harm, damage, claim, demand, cause of action, cost, or expense of any nature that my child or I may have or that may hereafter accrue, on account of any loss, damage, or injury that may be sustained by me, my child, or any other person/entity during, arising out of, or in connection with, my child’s participation in the Program. This waiver does not pertain to incidents involving gross negligence or willful misconduct by the University and/or its agents.

I also give permission to Releasees to authorize medical treatment for my child, including emergency medical transportation, which may be required for injuries sustained by my child. I understand and agree that if my child must be hospitalized or otherwise receive medical care, the University cannot and does not assume legal responsibility for payment of such costs. I understand that I am responsible for any medical costs incurred as a result of any personal illness or injury to my child, even if a Releasee has signed hospital documentation promising to pay for the treatment.

I warrant that I am the legal parent/guardian of the above-named participant and at least eighteen (18) years of age and fully competent to sign this Release; that I have read and am voluntarily signing this Release; and that this Release shall be construed in accordance with the laws of the State of Missouri. If any term provision of this Release shall be held unenforceable, illegal, or in conflict with any governing law, the validity of the remaining portions shall not otherwise be affected.

THIS IS A RELEASE OF LEGAL RIGHTS.

READ IT AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING.

ACCEPTED AND AGREED (Both parents, if possible):

Student's Birthdate*
Student's Birthdate*
Student's Mailing Address*
Student's Mailing Address*
Parent 1
Parent 2