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  • Blinn College Student Emergency Information Form

    Uploaded by

    Terra Drake
    4 views1 page
    This document collects emergency contact information from Blinn College students, including their name, personal cell phone number, emergency contact person's name and relationship, and that contact's phone number. It also requests information about any special medical conditions students may have that instructors or first responders should be aware of in case of an emergency.

    Original Description:

    Original Title

    Blinn College Student Emergency Information Form (1) (2)

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    This document collects emergency contact information from Blinn College students, including their name, personal cell phone number, emergency contact person's name and relationship, and that contact's phone number. It also requests information about any special medical conditions students may have that instructors or first responders should be aware of in case of an emergency.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Blinn College Student Emergency Information Form

    Uploaded by

    Terra Drake
    This document collects emergency contact information from Blinn College students, including their name, personal cell phone number, emergency contact person's name and relationship, and that contact's phone number. It also requests information about any special medical conditions students may have that instructors or first responders should be aware of in case of an emergency.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Blinn College Student Emergency Information

    Please complete the following. This information will be held in confidence by the instructor and
    destroyed after the semester is over

    Required

    Course and Section

    ______________________________

    Your name

    ____________________________________________________

    Your personal cell phone number (Not parent’s phone number)

    ___________________________________

    Person to contact in case of emergency

    Name_____________________________

    Relationship____________________________

    Phone number ____________________________

    Are there any special conditions that I (or an Emergency First Responder) might need to be aware of
    (diabetes, seizures, allergies, pregnancy)?

    __________________________________________________________________________________

    __________________________________________________________________________________

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