Fall Visit Day

Please be advised this program is designed for current high school seniors only.

* denotes a required field.

Student Information

First Name*

Preferred Name

Middle Name

Last Name*

Birthdate*

Sex

Gender Identity

If you choose, please share your gender identification.

If you choose, please share your preferred pronouns.

Contact Information

Email*

Cell Phone

Home Phone

Permanent Address*

Country

Street

City

Region

Postal Code

Is your mailing address different from your permanent home address?*

Yes

No

Mailing Address*

Country

Street

City

Region

Postal Code

Academic Information

Will you be entering as a FIRST-YEAR or as a TRANSFER student?*

College Entry Term*

Current School Name*

Current School CEEB Code

Current School Location

Country

City

Region

Postal Code

Travel Information

Will you be flying or driving to campus?*

In order to purchase your flight to Kenyon to participate in the Cultural Connections Overnight Program, Kenyon requires parent/guardian consent.*

By checking the box, I certify my parent/guardian has given consent for me to travel to Kenyon.

Preferred departure airports for travel to Kenyon (your return trip will be booked for return to the same airport).

First Preferred Airport*

Second Preferred Airport*

Please share your Known Traveler Number (if you have have one).

Please share your Redress Number (if you have have one).

Mailing Address*
This is where we will send your reimbursement check

Country

Street

City

Region

Postal Code

Arrival Information

Departure Address*

Country

Street

City

Region

Postal Code

Mileage from Departure Address to Kenyon (104 College Drive, Gambier, OH 43022)*

Departure Information

Return Address*

Country

Street

City

Region

Postal Code

Mileage from Kenyon (104 College Drive, Gambier, OH 43022) to Return Address*

Total Mileage

Upload a copy of Google Maps or another map source that shares the roundtrip mileage from your original destination to Kenyon and back.

Additional Student Information

Academic Interests*
(To make multiple selections, please and hold down the CTRL key on a PC or the CMD key on a Mac)

Athletic Interests
(To make multiple selections, please and hold down the CTRL key on a PC or the CMD key on a Mac)

Extracurricular Activities
(To make multiple selections, please and hold down the CTRL key on a PC or the CMD key on a Mac)

Guests and Accommodations

How many people will be joining you?*

Guest 1 First Name*

Guest 1 Last Name*

Guest 2 First Name*

Guest 2 Last Name*

Do you or a member of your party have any accessibility needs?*

Please provide further information about your accessibility needs.*

Do you or a member of your party have any food allergies or dietary restrictions?*

Please provide further information about your dietary restrictions.*

Parent/Guardian Information

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Parent/Guardian 1 Email*

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian Information
Please list the parent/guardian who has given consent for you to travel to Kenyon.

Parent/Guardian Relation*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Parent/Guardian Phone*

Code of Conduct

As an overnight guest of Kenyon, students are required to abide by the same rules and regulations that govern the conduct of current Kenyon students. Any negative or illegal behavior on your part during your campus visit will be considered by the admissions office and your offer of admission may be rescinded. The Office of Admissions will also report any violations to your secondary school.

Please acknowledge and agree to the following items:

I am aware that although Kenyon has agreed to host me overnight at the Kenyon Inn/The Mount Vernon Grand Hotel/The Holiday Inn Express, neither the Office of Admissions nor any other office or personnel of Kenyon will be supervising me at all times during my stay. Visiting students, like enrolled students, are responsible for their behavior.

I am aware that participants in visitation programs are required to abide by Ohio state law and the rules and regulations of student conduct that govern students enrolled at Kenyon. Violations of state law and campus regulations will be handled by the appropriate governing authorities.

I acknowledge that Ohio law prohibits the drinking of alcoholic beverages by persons under 21 years of age as well as use of controlled substances by persons of any age. As stated above, violations of this and any Ohio state law will be handled by the appropriate authorities.

I acknowledge that admissions staff have designated overnight accommodations for me.

Permission and Medical Release

The parent/guardian listed above acknowledges the following:

The parent/guardian has given the student permission to stay overnight at the Kenyon Inn/The Mount Vernon Grand Hotel/The Holiday Inn Express during the student's visit to Kenyon.

Parent/guardian hereby agrees to release, indemnify and forever discharge Kenyon, its Trustees, employees, and other agents, from and against any and all liability and responsibility for any claim or cause of action, including claims based on negligence on account of any other person/entity during, arising out of or in any way associated with student's visit at Kenyon.

In case of an emergency and if parent/guardian cannot be reached, parent/guardian authorizes a representative of Kenyon to consent to any medical treatment or care deemed advisable.

Final Acknowledgement

Student and parent/guardian have read and fully understand all the provisions of the Code of Conduct and Permission & Medical Release. By signing below, the student and parent/guardian acknowledges and agrees to the foregoing by typing their name's below.

Student's Full Name Typed Signature

Parent/Guardian's Full Name Typed Signature

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