Department of Residence Life
1032 W. Sheridan Rd. | Chicago, Illinois 60660
p (773) 508-3300 | f (773) 508-3311
Request Form for Minor Visitation in the Residence Halls
The Department of Residence Life strives to develop positive living and learning environments within the residence
halls at Loyola University Chicago. An important part of our role in this involves ensuring the safety of our students
as well as any visitors and guests, particularly those under age 18. For this reason, we request that the following
form be completed for any minor (under age 18) requesting to visit a Loyola University Chicago student in the
residence halls overnight without a parent or guardian. All requests will be reviewed on a case by case basis.
This form must be submitted (via fax, mail, in person, or scanned with signature attached to an e-
mail) no later than 12:00 pm on the business day (Monday – Friday) prior to the minor’s visit to the
residence halls. A Department of Residence Life staff member will contact the student host and/or guest directly
with the decision regarding the request for the minor’s visit.
This form must be completed and signed by the minor’s parent or legal guardian.
Minor’s Contact Phone Number (if applicable):
Age: Date of Birth: Gender:
Arrival Date/Time: Departure Date/Time:
Student Host Name: Residence Hall/Room #:
Cell Phone Number: Loyola ID:
Parent or Legal Guardian:
City: State: Zip:
Home Phone Number: Cell Phone Number:
E-Mail: Work Phone Number:
By signing this document, I understand that:
As a guest of Loyola University Chicago, my child is responsible for following all University policies (as
stated in the Student Handbook) as well as state and federal laws.
If at any time my child or their student host violates University policy, I understand that I may be contacted
to pick up my child immediately.
Submitting this form does not guarantee that permission will be granted for my child to visit Loyola
University Chicago overnight. The Department of Residence Life reviews requests for overnight visitation
on a case by case basis.
In consideration of Loyola University Chicago’s allowing my child to visit overnight, I hereby release and hold
harmless Loyola University Chicago, and each and every one of their affiliates and subsidiaries, as well as each of their
trustees, officers, representatives, employees and agents against loss from any and all claims or causes of action for all
known and unknown, foreseen and unseen, bodily injuries, damages to property and consequences thereof which
may be sustained by my child or by me arising out of, or in connection with, my child’s visit. In addition, I agree to
take full responsibility for any damage done to University property by my child during his/her stay at Loyola
Parent/Guardian Signature: __________________________________ Date: ______________
Completed forms can be returned:
In Person: Department of Residence Life (Simpson LLC, Room 107)
Faxed: (773) 508-3311
Mailed: Department of Residence Life, 1032 W. Sheridan Rd., Chicago, IL 60660
Staff Use Only
Date/Time Received: Received Via: Email Fax Mail
Approved Denied Reviewed By: