Fillable RESIDENCE APPLICATION (Northern Lights College)

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RESIDENCE APPLICATION (Northern Lights College)

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Student Services
Dawson Creek Campus
11401 - 8th Street
Dawson Creek, B.C.
V1G 4G2
Ph: 250-782-5251
Fax: 250-784-7563
RESIDENCE APPLICATION
Short Term
Please submit to Student Services
Campus of Studies Dawson Creek Fort St. John
NOTES
1. Applicant must notify the College in advance if s/he will not be attending classes as planned.
2. Application fee, where applicable, must by paid to Student Services at time of application.
Payment cannot be remitted by sending credit card information via FAX. Payment must be done
by phone or in person at Student Services at the campus where the applicant is attending.
3. Residence rental fees must be paid to Student Services on or before the rst day of occupancy.
Applications must be made a minimum of one business day in advance (24 hours).
4. Short-term stays include bedding, one set of towels, cooking and eating utensils and a small TV.
5. While all efforts will be made to meet individual room requests, NLC reserves the right to make
room assignments according to space availability at the time of application.
6. GST and PST (8%) will be applied to all rates.
538s/17.01.10-j
Name Student Number Birth Date* (YY/MM/DD) Gender M F
*if under 19 yrs, a parent or guardian must ll out Parental Consent/Release form
Permanent Address City Province Postal Code
Email Home phone Work phone Cell Phone
Program Start Date (YY/MM/DD) End Date (YY/MM/DD)
Expected occupancy start date (YY/MM/DD) Time
Expected occupancy end date (YY/MM/DD) Time (
Checkout is 4pm)
I am requesting: Number of nights required:
Four-bedroom unit:*
$40 per night (minimum two nights) or $240 per week (at rate), per occupant (Dawson Creek and Fort St. John)
Executive suite, 2-bedroom unit: Dawson Creek nightly rate per occupant: 1-4 nights $140 5 or more nights $125
Executive suite, 3-bedroom unit: Dawson Creek: $95 per night, per occupant Dawson Creek: $570 per week, per occupant
*Applicable application fees: NLC Student/Staff $50 Non NLC $100
Individuals with whom you would like to reside:
M F
Name
M F
Name
M F
Name
Signature Date (YY/MM/DD)
Incorrectly completed applications will be returned to the location of origin for correct completion. This may delay room reservation or booking.
OFFICE USE ONLY
Deposit amount paid $
Cheque Cash Visa MasterCard
Room/Unit assigned Date Initials
Northern Lights College reserves the right to modify or cancel any program, timetable, fees, or objective without notice or prejudice.
Please PRINT form and sign by hand
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Northern Lights College (NLC) has Residence space for students aged 17 and older. NLC strives to provide a safe and secure environment and is dedicated
to promoting safety in the residence and on the campus.
For students under 19 years of age, NLC requires a parent or legal guardian to complete this consent form in order for the Residence Application to be
processed. The following is not intended as an exhaustive list of issues that may arise in Residence, but is intended to assist in determining whether
Residence is right for your child.
1. Students living in residence are required to comply with all NLC Policies and Rules, including those outlined in the Residence Guide and Handbook.
2. Room assignments, where possible, are determined on the basis of age, gender and/or program of study. However, the age of students living in the
residency building may vary, and your child may be living near older students.
3. NLC is a non-smoking facility. Smoking or the use of tobacco in the Residence is strictly prohibited.
4. The use or possession of drugs anywhere on NLC grounds, including in the Residence, is prohibited at all times. Students found in possession of or
using any form of illicit drugs will be evicted from the Residence and the RCMP may be involved.
5. Students over the age of 19 are permitted to have and consume alcohol inside suites where all residents are age 19 or over; however, open alcohol is
not permitted in the hallways or recreational areas. All individuals in the residence can expect to come into contact with other students who have
consumed alcohol.
6. No adult supervision is provided in the Residence. Campus Security personnel are scheduled from 4 pm to 3 am seven days a week. A Residence
Manager oversees operations during regular weekday business hours. Neither Security nor the Residence Manager provides supervision.
7. Each Residence has a Resident Assistant(s). These are student leaders who are on call every day to assist students with complaints or concerns,
including students who become locked out of their rooms. The Resident Assistants do not provide supervision of students.
8. NLC does not provide meal services to students living in Residence.
9. Computers are available for use in Residence study areas, and wireless Internet access is available throughout the Residence. The use of these
computers is not monitored by NLC and therefore students have unrestricted access to the Internet. If there are websites you do not want your child to
view, you must discuss that issue directly with your child.
10. Televisions are permitted in all suites, and a television is provided in the common area. NLC does not monitor or restrict the programs or movies viewed
by students.
11. NLC is not responsible for any loss, theft or damage to the personal belongings of students kept in the Residence. NLC does not provide insurance
coverage for students’ personal belongings.
Consent and Waiver
I have read and understand this document, and the Residence Application Form. I have been provided a copy of the Residence Guide and Handbook and
have read and understand the same.
I hereby give my consent for my child, , to live in Residence at NLC.
In consideration of NLC permitting my child to live in Residence, I release and agree to indemnify and hold harmless NLC, its ofcers, employees,
contractors and agents from any claims and waive any and all claims I may have, now or in the future, including negligence, as a result of or that relate
in any way to my child living in Residence. Please note that this is not a release of information. Should the individual you are consenting to live in residence
wish to allow NLC permission to speak to regarding anything other than conrmation of form receipt he/she will have to contact Student Services at
1-866-463-6652 to request a Release of Information Form.
Signature of Parent / Guardian Name of Parent / Guardian Date (DD/MM/YY)
Parent Phone Number Parent email
Signature of Witness Name of Witness
Northern Lights College reserves the right to modify or cancel any program, timetable, fees, or objective without notice or prejudice.
Student Services
Dawson Creek Campus
11401 - 8th Street
Dawson Creek, B.C.
V1G 4G2
Ph: 250-782-5251
Fax: 250-784-7563
Parental Consent and Waiver
for Underage Students
538P/16.10.25-j
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Completed 19 October 2020

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