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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 be supervising or “chaperoning” 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 parent/guardian notification and high school notification.

I understand that the Office of Undergraduate Admissions will arrange for my child to stay in an on-campus apartment, in an 8 or 6-person suite that includes its own bathroom, on the University campus. Program activities include, but are not limited to: walking tours, other outdoor activities, off-campus dining and activities in the Delmar Loop, as well as a trip to the Pin-Up Bowl off-campus.

I understand and appreciate the dangers, hazards and risks inherent to the Program, including but not limited to transportation to, from, and around the Program locations via bus, MetroBus, MetroLink, walking or other modes of transportation, natural disasters, inclement weather, heat exposure, dehydration, accidents, falls, lacerations, burns, broken bones, insect or other animal bites, and other injuries (including injuries that could result from bowling and various outdoor activities), illnesses (including COVID), diseases, crimes, riots, terrorist activities or attacks, and any risks associated with independent activities my child may undertake as an adjunct to the Program, all of which could include serious or even fatal injuries or property damage or loss. Such damage, injuries and/or death may result not only from my child’s own action, inaction or negligence but also the action, inaction, or negligence of others. I further understand that the University, including the individuals acting on its behalf, cannot and does not assume responsibility for such events or personal injuries or property damage arising therefrom even if such injury or damage is a result of the negligence of the University or other parties released. I also accept that it is my child’s sole responsibility to participate only in those activities for which he/she has the prerequisite skills, qualifications, preparation, and training, and that I have read and understand the conditions applicable to the Program. I further accept and agree that my child will follow all instructions pertaining to the Program, particularly those regarding safety and security practices.

With full knowledge of the dangers, hazards and risks of the Program, and in consideration for my child being permitted to participate in it, 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. It is my express intent that this Release shall be deemed a release, waiver, discharge and covenant not to sue the Releasees. I further agree to save and hold harmless, indemnify, and defend Releasees from any claim by me or my family arising out of my child’s participation in the Program.

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 assume all risk and responsibility for my child’s medical needs, and 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.



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