Confidential Contact Registration Form
All students living on campus in a residence hall have the option to register a confidential contact person to be notified in the case that the student is determined missing. Only authorized Rocky Mountain College officials and law enforcement officials will have access to this information. This form will be filed in the Office of the Vice President for Student Life to be used in case of emergency only.
Student Name
*
First Name
Last Name
Residence Hall
*
Anderson
Jorgenson
Rimview
Widenhouse
Room Number
*
Name of Confidential Contact
*
First Name
Last Name
Relationship to Confidential Contact
*
Phone Number of Confidential Contact
*
Please enter a valid phone number.
Address of Confidential Contact
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I understand that should the Campus Safety Office (CSO) believe me to be missing they will notify, within 24 hours, the student’s Confidential Contact Person. If I am under the age of 18 and not emancipated the CSO must additionally notify my custodial parent or guardian.
*
Understand
Student Signature
*
Submit
Should be Empty: