Emergency Contact Form

Special Instructions:

In the event of a medical emergency, are there any emergency procedures or restrictions on medications of which emergency personnel should be aware? If yes, please explain.

Emergency Contacts:

Primary Contact in case of emergency:

Secondary Contact in case of emergency:

Physician Contact:

Employee Authorization:

I have voluntarily provided the above contact information and authorize Island Fusion Caribbean Restaurant and its representatives to contact any of the above individuals on my behalf in the event of an emergency.

SEND