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Emergency Contact Form
Enrollment Kit
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Contact Us
Hilbert College
Office of Admissions
5200 South Park Ave.
Hamburg, NY 14075
Franciscan Hall, First Floor
Phone: (716) 926-8780
Toll Free: 1-800-649-8003
Text: (716) 296-4350
Fax: (716) 649-0702
admissions@hilbert.edu
Office Hours
Monday - Thursday: 8:30am - 5pm
Friday: 8:30am - 4:30pm
Enrollment Kit - Emergency Contact Form
REQUIRED OF ALL STUDENTS. THIS FORM MUST BE SUBMITTED PRIOR TO START OF THE SEMESTER.
Please list your emergency contact information in the event of an emergency or life-threatening situation.
Student First Name
Click to add
(?)
Student Last Name
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(?)
Date of Birth
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XX/XX/XXXX
(?)
Street Address
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Street, City, State, Zip Code
(?)
Student Living
On-Campus
Off-Campus Commuter
PRIMARY EMERGENCY CONTACT
Full Name
Click to add
(?)
Relationship
Click to add
(?)
Primary Phone or Cell
Click to add
XXX-XXX-XXXX
(?)
Secondary Phone
Click to add
XXX-XXX-XXXX
(?)
E-Mail
Click to add
(?)
SECONDARY EMERGENCY CONTACT
Full Name
Click to add
(?)
Relationship
Click to add
(?)
Primary Phone or Cell
Click to add
XXX-XXX-XXXX
(?)
Secondary Phone
Click to add
XXX-XXX-XXXX
(?)
E-Mail
Click to add
(?)
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FOR MORE INFORMATION
Barb DeLaRosa • (716) 649-7900, ext. 123 •
bdelarosa@hilbert.edu