KEARNEY AGRICULRTURAL RESEARCH & EXTENSION CENTER

DORMITORY REQUEST, APPROVAL, AND REGISTRATION

Rate = $18 per night

Request and approval section, to be filled out prior to occupant arrival:

Sponsor (Faculty):	Request Date:

Phone:	Cell:	Email:

Occupant’s Name:	Sex: Male Female

Planned Occupancy:	Check in date:	Check out date:

Reservation Type: Continuous stay	Intermittent pattern: Daily Weekly Monthly

(If intermittent, you may keep your keys until the season is finished.)

Sponsor Account #:	Or Occupant will Pay

Special Requests:

By requesting dorm space, the Sponsor agrees to be responsible for the actions of the occupant. Occupants not abiding by the KARE dormitory rules, regulations, guidelines and policies will be asked to leave.

A Sponsor emailing this as an attachment serves as an electronic signature.

Approved By:	Date:

Note: KARE approval must be obtained before allowing dorm occupancy.

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Registration section; Occupant information; can be filled out when the occupant arrives:

Occupant’s name:

Phone:	Cell:	Email:

Address:

In case of emergency, please notify: Name:

Cell:	email:

By registering for dorm space, the occupant agrees to read and abide by all KARE dormitory rules, regulations, guidelines and policies.

Occupant Signature:	Date

Office Use only:	431 (302-M):	432 (301-F):

Revised Jan 2012

KEARNEY RESEARCH & EXTENSION CENTER

lvdstaay

2012-04-26

UC Kearney Ag Center