Fillable Emergency Contact List (Montana Tech)

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Emergency Contact List (Montana Tech)

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1300 W. Park Street | Butte, MT 59701 | mtech.edu | 406.496.4463
Emergency Contact List
Print or type your name, the name of the person we should contact in case of an emergency and
their phone number as well as the cell phone for each student. A copy of this form (or other approved
form) must accompany the Student Travel Itinerary Form. If the group is not all traveling together,
include how each person is traveling to the destination. This list is to be used for your final check of
who is traveling and turned in on the day of travel.
Campus Contact Person: __________________________ Phone: ________________
Roll Call:
Check if
present
Name/cell phone # students in
Tech vehicle
Name/cell phone # students
taking personal vehicle- include
license plate #, or students with
trip alterations (leaving early,
staying late, taking different
vehicle)
Name/cell phone
# emergency
contact person(s)
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Emergency Contact List (Montana Tech)

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Completed 26 July 2020

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