Arrival and emergency information form

This form contains one or more fields that will be filled automatically after you log on with a Fontys account.

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Personal details

Please fill in your personal details and arrival times below.

First name

This field is required.

Last name

This field is required.

E-mail

This field is required.

Please enter a valid email address.

Nationality

This field is required.

Phone

This field is required.

Date of arrival

Time of arrival at Venlo station

Name of buddy

Emergency contact person

Below you can fill in the details of a person we can contact in case of an emergency. Of course we do not hope for an emergency, but if something happens to you, the university will contact your emergency contact person.

Your emergency contact person should be someone from your home country.

Name of emergency contact person at home

This field is required.

Type of relationship (e.g. father, mother)

This field is required.

Address

This field is required.

Postal code

This field is required.

Home phone number

Mobile phone number

Email address of emergency contact

This field is required.

Please enter a valid email address.

Additional information / Remarks

Insurance

I accept that I am solely responsible at any time for having taken out an insurance policy. Fontys University of Applied Science is not responsible nor does it accept any liability whatsoever for the fact that an insurance policy has not sufficiently been taken out, nor that it has been concluded at all.

Please make a selection

Advice: Print this form twice. Bring one to Venlo and leave one at your contact address at home.