YMCA OF GREATER NEW ORLEANS
EMERGENCY CONTACT FORM Staff Member’s Name First _______________________
Middle Initial _____
Last name __________________
Nickname ___________________________ Email Address _____________________________________ Home # ______________________________
Cell # _______________________________
Department __________________________________________________
#1 Emergency Contact Person’s Name _______________________________________ Relationship to Employee _________________________________________________ Work # ________________________________
Home # _________________________________
Pager # ________________________________
Cell # ___________________________________
#2 Emergency Contact Person’s Name _______________________________________ Relationship to Employee _________________________________________________ Work # ________________________________
Home # _________________________________
Pager # ________________________________
Cell # ___________________________________