Emergency Locator Service form

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This service provides a system for family members to get in touch with a student during the school day in emergency situations. WOU Students provide information about their current class schedule so that in case of emergency, children, child care providers, or family members can call and have a message delivered to the student in the classroom. The form needs to be updated each term.

Name *

Address *

WOU Email address *

V number *

Phone number--cell, home, pager *

Alternate person to call if we cannot reach you (name and phone number) *

Names and phone numbers of spouse/partner, caregivers/daycare, schools or employer that may call us in the event of an emergency:

Names of Children who may call us in the event of an emergency:

Please check one: *

This information may be released only to the those designated on this form

This information is considered public information

Current Term Class Schedule *

By checking "Yes" below you agree that the information provided is accurate and can be released based on the wishes indicated. In addition, this will be valid for one academic term only. *

Yes

Required

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