Student Emergency Contact Information

For Seton Hall Law Students

Name*

First Name

Middle Name (optional)

Last Name

Email*

SHU Email, if current student. Confirmation of this registration will be delivered to this address.

Seton Hall ID Number (SHUID)*

Phone*

(ex. 123456789)

Alternate Phone

School Year Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Emergency Contact*

First Name

Last Name

Relationship*

Emergency Contact Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Emergency Contact Phone*

I understand that the information provided on this form is confidential and will be used only in the event of an emergency. In case of an emergency in which I am at risk of harm (from myself or others) or have been injured, harmed or am ill, I authorize the University to contact the individual listed above, whose information I have provided, and to disclose what has happened to me, my condition, and my location, including whether I am being admitted to a hospital. Further, I authorize you to disclose any necessary information included above to any individuals who are providing aid in such an emergency so that they may provide the appropriate assistance.*