Athletics Overnight Hosting Request

Please use this form to provide the Office of Admissions with the contact information of prospective student-athletes being hosted on campus, along with the details of an emergency contact for the student.

*denotes a required field.

Athletics Information

Pomona Coach's Name *

Sport *

Hosting Information

Prospective's Date of Arrival (MM/DD) *

Prospective's Date of Departure (MM/DD) *

Host's Name *

Host's Mobile Number *

Host's Room Number *

Prospective Athlete's Biographical Information

Email Address *

First/Given Name *

Middle Name

Last/Family Name *

Nickname/Preferred First Name

Sex *

Birthdate *

I will be 18 years of age or older on the day of my stay. *

Yes

Mailing Address *

Country

Street

City

Region

Postal Code

Phone Number *

High School Name *
Type the first few characters, then select from the list that appears.

High School Graduation Year *

Are you a prospective first-year or transfer applicant? *

First Year

Transfer

Please provide any additional notes or concerns of which you think we should be aware.

Emergency Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

What is this person's relationship to you? *

Signatures

For the student:

"As a guest of Pomona College’s Overnight Hosting program, I understand that during my stay I am expected to behave responsibly and respectfully. I also understand that I am responsible for my own decisions and conduct. Students must adhere to all local, state and federal laws in addition to campus policy including those related to alcohol and drugs."

By typing your name below, you indicate your agreement with the above statement.

For the student:

"In the event that neither I nor the designated emergency contact person(s) can be reached, I authorize and consent to medical, surgical, hospital care, treatment and procedures which is/are deemed immediately necessary by the treating physician to safeguard my health."

By typing your name below, you are agreeing to the above statement.

For the student's parent or guardian:

"In the event that neither I nor the designated emergency contact person(s) can be reached, I authorize and consent to medical, surgical, hospital care, treatment and procedures which is/are deemed immediately necessary by the treating physician to safeguard my child’s health."

By typing your name below, you are agreeing to the above statement.

"I gave my first gift to Pomona as a first-year. Working as a caller for the Annual Fund, I knew participation was key to the success of the program. I also give because of the generous financial aid I receive."

November Baez Trejo '16