York University - Safety Abroad, Travel Registration

Requesting Information on Voluntary Basis:

To register your international travel with the University please complete and submit the following information. Once registered you will receive all needed travel reference information including how to contact York University in case of an emergency abroad or an emergency at home.

Emergency Information:

(Confidential)
Name Name First Last
Academic Department & Faculty
Email
Canadian Home Address Canadian Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Destination(s)
Citizenship (If Not Canadian)
Departure Date Departure Date / MM / DD YYYY
Return Date Return Date / MM / DD YYYY
Any Additional Dates or Information
Address - Host Location Address - Host Location
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone - Host Location Phone - Host Location - ### - ### ####

Host location phone number, mobile number, or what number is best so that you can be reached?
Alternative Contact Info
Preferred Method of Contact

Preferred Method of Contact Phone Email Other Other
Travel / Medical Insurance Company Name
Emergency Contact

Give the name and address of a designated person who is a point of contact in the event of an emergency:
Emergency Contact - Name Emergency Contact - Name First Last
Emergency Contact - Relationship
Emergency Contact - Address Emergency Contact - Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact - Phone (Home) Emergency Contact - Phone (Home) - ### - ### ####
Emergency Contact - Phone (Cell) Emergency Contact - Phone (Cell) - ### - ### ####
Emergency Contact - Phone (Business) Emergency Contact - Phone (Business) - ### - ### ####
Emergency Contact - Email
Personal Information

Please do ensure that your EMERGENCY CONTACT has copies of your personal information including passport, medical/ travel insurance information, any pertinent medical information that may be of significance to a health care provider in an emergency situation.

York University - Safety Abroad, Travel Registration

York University - Safety Abroad, Travel Registration

Emergency Information:

Emergency Contact

Personal Information