Emergency Contact -

Dear Teachers:
We are collecting emergency contacts from all of us. Please note that this information will be kept privately and used in emergency situations only.
There are two emergency contacts slots. You can use one emergency contact here in China and the other one in your home country. We do; however, need at least one emergency contact.
Thank you for your response.

Luciane



A red asterisk (*) indicates required questions.


  1. Last name:*


  1. First name:*


  1. Your phone number in China:
    86 *


  1. Your address. Choose one*
    Qinshanshui
    Shangpin
    Yuanyang
    Campus


  1. Block#


  1. Building#


  1. Apartment#*


  1. Primary Emergency Contact:*


  1. Relationship to you:*


  1. Phone Number(with area code):*


  1. Full address:*


  1. Email address:*


  1. Secondary Emergency Contact's Name:


  1. Relationship to you:


  1. Phone Number(with area code):


  1. Full address:


  1. Email address:


  1. Any additional relevant information you would like to share?





NJ