Please print form, fill out, and fax back to the dean’s office at 603.569.7199. This form cannot be submitted online.
Parents: Please mail this form directly to the dean of students' office so that it is received no later than 3 p.m. on the Wednesday before the anticipated departure. Faxed copies are accepted at 603.569.7199. A letter containing this information is an acceptable substitute.
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My son/daughter, __________________________________________, has my permission to take a regular weekend away. |
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| Departure Day and Date: __________________________ | Time: ______ __ a.m. __ p.m. |
| Return Day and Date: _____________________________ | (no later than 7:45 p.m.) |
| His/her destination will be the home of: | |
| Name: | ____________________________________________ |
| Address: | ___________________________________________ |
| ___________________________________________ | |
| Phone: | ____________________________________________ |
His/her specific means of travel will be:
Departure: ________________________________________
Return: ___________________________________________
I have contacted the host family where my son/daughter will be visiting:
___ yes ___no
Please check one and sign below.
Permission is granted with the understanding that this may be an unsupervised, co-ed weekend.
____ yes _____ no
| _______________________________________ | ______________ |
| Parent/Legal Guardian Signature | Date |
For your child's off campus weekend to be considered, this form must be completely filled out.