PERMISSION/MEDICAL RELEASE FORM & HONOR CODE FORM- Wellesley College Spring Open Campus 2014

A completed Permission/Medical Release Form is necessary for any student attending Spring Open Campus, even those not spending the night on campus. A parent or guardian is required to complete the first part of the form. Please complete this form at least 48 hours prior to arriving on campus. You will not be allowed to participate in the program without completing this form. As a guest on campus, you are also required by Wellesley College to assume the same responsibility for your own actions that Wellesley College students assume. We ask that you read Wellesley's Honor Code statement, provided at the end of this form, and sign your name to indicate that you understand the statement, and agree to abide by it during your time on campus. The information you provide in this form will be held by Campus Police and the Office of Admission. It will be confidentially destroyed at the conclusion of the program. If you have any questions, please contact the Office of Admission. Wellesley College Office of Admission 106 Central Street, Wellesley, MA 02481 p: (781) 283-2270 f: (781) 283-3678 admission@wellesley.edu
* Required




PART I: Medical Release Form and Emergency Contact Information


For the Parent/Guardian

I give permission for my child, named above, to visit Wellesley College. I hearby release, indemnify, and hold harmless Wellesley College, its trustees, officers, agents, and employees from any and all liability, damage, claim of any nature whatsoever arising out of or in any way related to my child's participation in this visit to Wellesley College. In case of any emergency and if we cannot be reached, we the undersigned parent or guardian of the above child, do hereby authorize a representative of Wellesley College to consent to any medical treatment or care deemed advisable.




For the Student

I have read and fully understand all the provisions of the Permission/Medical Release Form as detailed in the Parent/Guardian section above.



Emergency Contact Information

In the case of an emergency, Campus Police may use the following information to contact the student and/or her family as well as to give accurate information to medical personnel if needed.









Part II: Wellesley College Honor Code

The Wellesley College honor system is central to our mission as a liberal arts college. It is a system of mutual trust and respect upon which we base our community. Honor is the foundation of teaching, learning, and community life at Wellesley, and all students share responsibility for preserving this foundation. The Wellesley College Honor Code is as follows: As a Wellesley College student, I will act with honesty, integrity, and respect. In making this commitment, I am accountable to the community and dedicate myself to a life of honor.

Please read the following statement, and sign at the bottom: I am aware that although Wellesley College has agreed to host me for a program and/or overnight, neither the Office of Admission nor any other office or personnel of Wellesley College will be supervising me at all times during my stay on campus. Visiting students, like enrolled students, are responsible for their behavior as adults within the expectations described below. I am aware that participants in the campus visit programs are required to abide by Massachusetts state law and the Honor Code which governs students enrolled at Wellesley College. I acknowledge that Massachusetts law prohibits all use of illegal drugs and prohibits the drinking of alcoholic beverages by persons under 21 years of age. I acknowledge that the Wellesley College Honor Code, which is posted above, requires every student to uphold and obey all duly adopted rules of the College for the government of academic work, for the use of College resources, and for the conduct of its members. Further, I understand that any negative behavior during my campus stay will be considered by the Office of Admission. Any violation of the rules stated above or any damages to Wellesley College property may impact my application to Wellesley College. My signature below indicates that I have read all statements above, that I understand this content, and that I agree to comply with the above requirements.



Thank you!

Thank you for completing the two required forms (Medical Release and Honor Code). Make sure that you've registered for Spring Open Campus and that you received a confirmation email for your registration. We'll see you soon! Press the Submit button once and wait for the confirmation screen. You will not receive a confirmation email from this form, and the screen on the next page is your assurance that the forms were successfully submitted.

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