Trip Registration for Public Safety

This form is to be used by any student organization, academic department or athletic department sponsoring a trip. It is important that each person who will be traveling provide contact information in case of an emergency.

Fields marked with * are required.

* Student Organization / Academic Dept /Athletic Dept:

* Faculty Advisor / Responsibility Party:

* Faculty Advisor / Responsibility Party Email:

* Destination of Trip:

* Date of Trip:

* Departure Date/Time:

* Return Date/Time:

* Provide travel information to include where you can be reached in case of an emergency while traveling.

Each traveler should note below who the College should contact in case of an emergency:

Traveler	Phone	Emergency Contact Person	Emergency Contact Phone

* In order to help prevent abuse of this form, please enter the red character in the following image: