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Asian Pacific Islander Overnight Consent Form
Thank you for your interest in participating in the Asian Pacific Islander Overnight program,
scheduled to be held on Sunday, April 12 through Monday, April 13, 2015. Please read the
information below, sign the form, and if you are under 18 years of age, have your parent sign as
well.
The Asian Pacific Islander Overnight program is limited to activities on the Loyola Marymount
University campus. The University will not supervise or in any way be responsible for any offcampus travel or activity. Each visitor will stay in an on-campus residence hall or apartment,
which is staffed by trained personnel, and will be hosted by an LMU student.
I have read and understand the description of the Overnight program stated above.
Name of Visiting STUDENT
Cell Phone # of STUDENT
Signature of Visiting STUDENT
Today’s Date
Name of PARENT/GUARDIAN of Minor Participant
Phone # of PARENT/GUARDIAN
Signature of PARENT/GUARDIAN
Today’s Date
In the event of an emergency and if unable to contact above, please contact:
Name of Emergency Contact
Phone # of Emergency Contact
***Please complete and email this form to [email protected] or fax the form attention to
Ashley Watterson at (310) 338-2797. This consent form must be received in the Admissions
Office no later than Friday, April 10. If you have any questions or concerns, please call Ashley
Watterson at (310) 338-7395.
For office use only:
LMU Student Host
Cell Phone #
Residence Hall & Room #
Residence Hall Extension #