Village Community Services Emergency Contact Form
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1EMERGENCY CONTACT FORM
VILLAGE COMMUNITY SERVICES
3210 Smokey Point Drive, Suite 200
Arlington, WA 98223
TO BE FILLED OUT BY EMPLOYEE
NAME
ADDRESS
___________________________
CITY
STATE________ZIP ___________
HOME PH
CELL PH ____________________
EMERGENCY INFORMATION
NAME OF PERSON TO NOTIFY IN CASE OF EMERGENCY:
NAME
RELATIONSHIP
ADDRESS
___________________________
CITY
STATE________ZIP ___________
HOME PH
CELL PH ____________________
WORK PH
MSG PH ____________________
______
______________
EMPLOYEE SIGNATURE
DATE
When there are changes in this information, please complete a new employee information form and return
to the Main Office.
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Parent category: Business