Sinkor Beauty Salon

4446 Summit Bridge Rd, Middletown, DE 19709 | (302) 464-3292

Emergency Contact Form

Employee Information

Full Name

Date

Position / Department

Hire Date

Primary Emergency Contact

Contact #1

Full Name

Relationship

Phone Number

Street Address

City, State, Zip

Contact #2

Full Name

Relationship

Phone Number

Street Address

City, State, Zip

Medical Information (Optional)

Primary Physician Name

Phone

Known Allergies or Medical Conditions (confidential — for emergency use only)

Authorization

I authorize Sinkor Beauty Salon to contact the persons listed above in the event of an emergency. Medical information provided is kept confidential and used for emergency purposes only.

Employee Signature

Date