Emergency Contact Forms
Any group or organization leaving campus on an overnight trip must fill out the attached forms and return them to the VSA Vice President for Activities and the Dean of Students at least 10 days prior to departure.
Please email the completed forms to and
GROUP ITINERARY
1) Please include a complete schedule, day by day, of the trip.
2) Please include names and contact information for Hotels and dates if there are multiple accommodations.
3) Please provide the name of and contact information for your Transportation Company, if applicable.
MAIN EMERGENCY CONTACT INFORMATION
Name of Group or Organization: ______
Destination: ______
Dates of Trip: Leave ____/_____/20___ Return ____/_____/20___
Number of Members Traveling: ______
Contact Person in Charge (traveling with the group)
Name: ______
Title: ______
Phone: ______
E-Mail: ______
On-Site Contact Person (If applicable)
Name: ______
Address: ______
Phone: ______
E-Mail: ______
Flight Information (If applicable)
Departure Arritval
Date: ______Date: ______
Airline(s): ______Airline(s): ______
Flight#: ______Flight#: ______
Layover Info: ______Layover Info: ______
Driving Information (If applicable)
Driver: ______
Vehicle being used (student, security): ______
Has the driver taken defensive driving? Y/N
Driver: ______
Vehicle being used (student, security): ______
Has the driver taken defensive driving? Y/N
Driver: ______
Vehicle being used (student, security): ______
Has the driver taken defensive driving? Y/N
Driver: ______
Vehicle being used (student, security): ______
Has the driver taken defensive driving? Y/N
PARTICPANT CONTACT INFORMATION
(Must be filled out by every person going on the trip)
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______
Name of Organization Member: ______
Emergency Contact Name (during dates of trip) ______
Relationship to Org. Member: ______
Emergency Contact #: ______
Emergency Contact E-Mail: ______