Destiel® Emergency Contact Form

This form is used to collect emergency contact information for all volunteers at Destiel. Please provide the following information accurately.

Volunteer Information

Name:
Email:
Phone Number:
Address:

Emergency Contact Information

Contact Name:
Relationship to Volunteer:
Phone Number:
Alternate Phone:
Email:

Acknowledgment and Consent

By signing below, I confirm that the information provided above is accurate and complete to the best of my knowledge. I consent to Destiel using this information in the event of an emergency.

Volunteer Name:
Date: April 27, 2025

Volunteer Signature:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

November 17, 2024 1:21 pm CDT

Destiel® Emergency Contact Form Uploaded by Team Destiel - IP 108.92.171.89