CCTMQG Retreat Emergency Contact Information
The information you provide here is confidential and will only be used in case of an emergency occurring while you are here on retreat. If a medical emergency should arise, the information will assist medical personnel and help put us in touch with your family. This information is to be kept in an envelope under your sewing machine.
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Personal Information
Last Name____________________________ First Name ____________________________
Address______________________________________________________________________
City___________________________ State______________ Zip Code__________________
Home Phone___________________________ Cell Phone__________________________
Emergency Contacts
Last Name____________________________ First Name ____________________________
Home Phone___________________________ Cell Phone___________________________
Last Name____________________________ First Name ____________________________
Home Phone___________________________ Cell Phone___________________________
Medical Information
List any medical restrictions or impairments which you believe medical personnel should know in the event of an emergency. You may want to include vital medication as well.
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