Emergency Services & Contacts

2010-2011

To be provided to student upon his/her arrival with host family

STUDENT: ______Club:______

Club Counselor: ______

(Same gender as student/not a hosting family) (day phone) (evening phone)

Club Youth Exchange Officer: ______

(day phone) (evening phone)

Club President:______

(day phone) (evening phone)

Two (2) Local Non-Rotarian Contacts: (school counselor, coach or principal, police officer, etc.)

Name (1):______

(day phone) (evening phone)

Name (2):______

(day phone) (evening phone)

Country Representative/Contact: ______

(day phone) (evening phone)

District Governor: ______

(day phone) (evening phone)

Cowboy Country Youth Exchange Committee-Crisis Management Team

Long –Term Program

Bobbe Fitzhugh- Chairperson-307-358-6457 Home / 307-359-3311 Cell /

Beth Vandewege- Co-Chairperson-307-638-1273 Home/307-630-2441 /cell /

Ray Leaycraft – District 5440 Protection Officer – (970) 586-8599 Home/(970) 481-5078 cell/

Bryan Cooke – District Governor – 970-353-8303/

Emergency: 911

Local Police Department: ______

U.S. Department of State: 1-866-283-9090/

Rotary International: 1-847-866-3000 www.rotary.org

Cowboy Country Youth Exchange: www.rotary5440.org

General Resources: (please complete with the inclusion of local resources)

Problem / National
Or Local / Agency
Name / Contact
Number / Information
A.I.D.S. / National / NSTD / 1-800-227-8922 or for Spanish
1-800-344-7432 / Information on sexually transmitted diseases
Alcohol-
Drugs / National / National Youth Crisis
Hotline / 1-800-442-4673 / Help with drugs, alcohol, sexual
Assault (rape), depression,
homelessness
Local
Eating
Disorders / National / ANAD-National Assoc. of Anorexia Nervosa &
Associated Disorders / 1-847-831-3438
(long distance)
Local
Family Violence / National / National Domestic
Violence / 1-800-799-7233 / Spanish speaking counselors on duty
Local
Rape / National / RAINN (National Rape
Crisis Hotline) / 1-800-656-4673
Local
Suicide / National / Covenant House Hotline / 1-800-999-9999
Local
Local Rotary Safe House – families who have cleared background checks and have agreed to offer student safe haven in the event of an emergency:
Name (1):______
(day phone) (evening phone)
Name (2):______
(day phone) (evening phone)

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