Kentucky School for the Deaf: Student Life - Dormitory Permission Form

*Form must be completed at least 24 hours prior to the stay in the dorm.

*Parent/Guardian is responsible for notifying their local district that the transportation plan has changed.  

*If a student will be staying overnight in the dorm for a period of time, an ARC will need to be requested.

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I give permission for my child to stay after school in the Dormitory at the Kentucky School for the Deaf on a specified date or dates. I understand that approval depends on my child’s good behavior in school and that my child shall follow the dormitory rules. Students who stay in the dorm will remain under the dormitory staff and rules for the entirety of the event. Students will not be permitted to be signed out during the day and signed back at night in order to elude day time dorm rules. In the event that a child does not follow the rules, parents will be contacted and the child will lose dorm privileges for the remainder of the year.

 I agree to release, indemnify, and hold harmless the Kentucky School for the Deaf, its agents, and employees from liability for bodily injury or property damage that might occur during this event.

Please click the link below to review dorm expectations:

https://drive.google.com/file/d/1XyNKTLah_V07BDT3Nrv4R8ZXt6h08OvY/view?usp=sharing 

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Email *
Student Name: *
Student Grade: *
Dates of stay in dorm:  *
Days of the Week: (select all that apply)
Reason for stay in dorm:
(please re-submit this form for participation in each different event) *
Will the student be eating meal(s) on campus?  *
Special Instructions (diet restrictions, allergies, etc. . . ) *
Will medication need to be given during this stay?  (Reminder: a form from the primary care physician MUST be on file with the Health Center to administer any medications, including over-the-counter medication.) *
Parent/Guardian Signature: 
(by typing your name below, you agree to above statements and acknowledge you have viewed and accept the dorm expectations) *
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