Insurance & Risk Management Forms	INSURANCE & RISK MANAGEMENT TEL NO: (818) 677-2079 FAX NO: (818) 677-5853 MAIL DROP: 8284
	Academic Field Trip
	Participant List

PLEASE MAINTAIN THIS LIST FOR TWO YEARS IN THE ACADEMIC DEPARTMENT
Academic Department:	College:
Academic Field Trip Descriptive Title:	Field Trip Begins:	Field Trip Ends:
Faculty/Staff Emergency Contact Person:	Phone:	Alt Phone:

PARTICIPANT'S NAME:

EMERGENCY CONTACT'S NAME/RELATIONSHIP:

CONTACT PHONE:

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