Family Contact Information Form - Pilgrim Place printable pdf download

Family Contact Information Form - Pilgrim Place

Pilgrim Place Residents’ Family Contact Information Form

Pilgrim Place maintains a list of residents’ children to contact in case of emergency and to

receive periodic invitations to Pilgrim Kin events on campus, the monthly e-Newsletter, and

other Pilgrim Place mailings. Please provide the following information and return this form to

the Pilgrim Place Director of Admission, 625 Mayflower Road, Claremont, CA 91711.

_____________________________________ ______________________________________

Printed name of New Resident

Printed name of Spouse/Partner, if applicable

New Resident Address: __________________________________________________________

City, State, Zip: ________________________________________________________________

Phone Number: ________________________________________________________________

Email: _______________________________________________________________________

▬▬▬

Child’s Name: _________________________________________________________________

Address: _____________________________________________________________________

City, State, Zip: ________________________________________________________________

Phone Number: ________________________________________________________________

Email: _______________________________________________________________________

Receive all mailings ____, or Contact only in an emergency ____.

Child’s Name: _________________________________________________________________

Address: _____________________________________________________________________

City, State, Zip: ________________________________________________________________

Phone Number: ________________________________________________________________

Email: _______________________________________________________________________

Receive all mailings ____, or Contact only in an emergency ____.

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Family Contact Information Form - Pilgrim Place