Emergency Contact Form

EMERGENCY  CONTACT  FORM

 

Name _______________________________________________

 

Primary  Emergency  Contact

 

Name _______________________________________________

 

Relationship to Church Member __________________________

Phone ________________________   Cell Phone _______________

 

Secondary  Emergency  Contact

 

Name _______________________________________________

 

Relationship to Church Member  _________________________

Phone _____________________      Cell Phone _______________

 

Other  Information

Allergies (Food, insects, etc.) ____________________________________

 

 

I give my permission to contact the above named person(s) in case of an emergency.

Name _________________________________  Date _____________