Emergency Contact Form

Emergency Contacts
The College would like to have emergency contact information for employees and volunteers on file so that someone can be contacted if there is a serious injury, sudden illness, or other emergency while at Kentucky Wesleyan. This information will not be shared with any other college department or external entity except for these types of situations. Providing emergency contacts is completely voluntary. Please do not list minors as a contact.
Your name*
You are a(n)*
- employee
- volunteer
Primary Emergency Contact
Name*
Relationship
Phone*
Phone
Secondary Emergency Contact
Name
Relationship
Phone
Phone
Optional: Email
If you would like a copy of this form emailed to you, please include your email address below.

Emergency Contacts