Student Visitation Agreement
Please check all that apply:
Prospective Student
Enrollment Staff
Athletic Recruit Sport/Coach
Overnight Guest of Student Host Student
The following visitation agreement is designed to insure the safety and protection of the student host, the visitor, the parents of
the visitor and Randolph-Macon College. Please read completely and sign. Enjoy your visit!
Overnight Guest Policy: Overnight Guests (same or opposite sex), are allowed but no more than two consecutive nights and not
more than two, two night periods within a 30 day period. The Host Student of an overnight guest, must obtain permission from
their roommate before the guests arrival. All non-R-MC overnight guests must be registered with Campus Safety. Overnight
guests are not allowed when Residence Halls are closed or during exam week (for students and non-students)
Visitor’s Name Visitor’s Date of Birth
Visitors Address Visitor’s Cell Phone Number
Date of Arrival Date ofDeparture Visitor’s Temporary R-MC Vehicle Tag Number
Visitor VehicleInformation: Make Model License Plate Number
VISITOR RESPONSIBILITIES:
I agree to:
Stay with my student host at all times.
Not consume alcohol (if under 21) or illegal drugs during my visit.
Use good judgment and adhere to safety precautions and guidelines as may be set forth by College
officials.
Register my vehicle with Campus Safety
Adhere to and respect all Residence Life, Greek Life, and Code of Student Conduct policies and
the laws of the Commonwealth of Virginia.
Be responsible for my behavior and the results of my actions while I am a visitor at R-MC.
FAILURE TO ABIDE BY THIS AGREEMENT MAY RESULT IN LOSS OF VISITATION PRIVLEGES TO R-MC AND/OR REMOVAL FROM
THE R-MC CAMPUS AND/OR AFFECT YOUR ELIGIBILITY FOR ADMISSION
Visitor Signature Date
TO BE COMPLETED FOR PROSPECTIVE STUDENTS, ATHLETIC RECRUITS AND OVERNIGHT GUESTS UNDER 18 YEARS OF AGE.
Parent orGuardian Name(s)
Home Phone Number Mobile Phone Number
Residence
PARENT OR GUARDIAN RESPONSIBILITIES:
I agree to:
Leave phone and lodging/residence information for contact in the event of an emergency.
Disclose any medical conditions (see reverse side) that might need attention during the visit.
Hold harmless R-MC, its employees, students and trustees of any responsibility for any
behavior on the part of my son or daughter and the results of said behavior which may violate
this agreement, local laws and/or College policies.
Discuss the contents of this agreement with my son or daughter to ensure their compliance
with it.
Parent or Guardian Signature Date
Host’s Name ResidenceHall
Room Ext MobileNumber
HOST’S RESPONSIBILITIES:
I agree to:
Stay with visitor at all times.
Report any medical conditions/emergency to the College immediately at (804)752-4710
Report immediately any policy violation to a College Official.
Never take a prospective student or athletic recruit Off- Campus without the express
permission of the authorizing official.
Abide by all policies as stated in Residence Life and Housing Policies, Greek Life Policies and
the Code of Student Conduct and the laws of the Commonwealth of Virginia.
I UNDERSTAND THESE INSTRUCTIONS AND THAT FAILURE TO ABIDE BY THIS AGREEMENT MAY RESULT IN JUDICIAL ACTION, AS
WELL AS ADDITIONAL ADMINISTRATIVE ACTION
Host signature Date
Medical Consent Form
The following consent form should be completed and signed by a parent or guardian so that indicated medical care may be
given without unnecessary delay. No major procedures will be performed, except in extreme emergencies, without the parents
or guardians of the prospective student/athletic recruit/overnight guest being notified and fully informed, unless the prospective
student/athletic recruit/overnight guest has achieved at least 18 years of age.
I GIVE PERMISSION TO ANY QUALIFIED COLLEGE OR OTHER EMERGENCY MEDICAL PERSONNEL TO CARRY OUT SUCH
EMERGENCY DIAGNOSTIC AND THEREAPUTIC PROCEDURES AS MAY BE NECESSARY FOR MY SON/DAUGHTER TO
RENDER EMERGENCY CARE AND ANY OTHER MEDICAL CARE.
Prospective Student/Athletic Recruit/Overnight Guest Name (PLEASE PRINT)
Name of Parent or Guardian of Prospective Student/Athletic Recruit/Overnight Guest, if under 18 (PLEASE PRINT)
Medical Condition(s)/Allergies to Medication(s)
Current Medication (s)
Parent/Guardian Signature or Guest Signature if over 18 Witness
Emergency Contact Information
Name of Emergency Contact
Relation to Guest
Home Phone Number
Mobile PhoneNumber
Campus Safety
:
From mobile phone (804)752-4710
Emergency Services
:
From Campus phone9-911
From Mobile phone 911
THIS FORM MUST BE RETURNED TO CAMPUS SAFETY AS SOON AS IT IS COMPLETED AND SIGNED
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