Student Emergency Information

    Instructions
    Please complete all sections of this form.  The confidential information on this form is strictly for the Office of Student Life and will not be released to anyone without written consent except to authorized personnel in the event of an emergency.
    Personal Information
    Mailing Address
    Mailing Address
    Birthdate
    Birthdate
    Persons to Notify in Case of Emergency
    Permission for Treatment
    I consent to any necessary first aid by appropriate OCU personnel, and I further consent to such necessary health care treatment and medical procedures that may be deemed appropriate by licensed physician in a medical facility.  I also authorize to disclose necessary information to off campus health care providers as needed to treat an injury or illness.
    Insurance Information: 
    Students should have an insurance card to bring to campus for emergency situations.