ACS Volunteer Emergency Contact Form (South Atlantic Conference)

To be completed by individuals volunteering at a location other than the church where they are a member.

Your Name * Required

Your Gender * Required

Your Date Of Birth * Required

Your Mobile Phone Number * Required

Your Email * Required

Your Home Address * Required

Your Church Name * Required

What State Is Your Church Located In? * Required

Emergency Contact's Full Name (Primary) * Required

Emergency Contact's Phone Number * Required

Emergency Contact's Home Address * Required

Emergency Contact's Relationship To You * Required

Emergency Contact's Full Name - (Secondary)

For What Type of Emergency May South Atlantic Conference Contact This Emergency Contact? * Required

Accidents / Incidents

Loss of Life

Emergency Contact's Phone Number

Emergency Contact's Home Address

Emergency Contact's Relationship To You

This Form Will Be Valid For A Period Of 1-Year, Unless Withdrawal Is Requested By The Volunteer. I Give SAC Permission To Contact My Emergency Contact As Stated Above. * Required

YES

For What Type of Emergency May South Atlantic Conference Contact This Emergency Contact?

Accidents / Incidents

Loss of Life

Please state the event/ campaign you are volunteering for and the expected dates you will serve: * Required

Today's Date * Required

Less Annoying CRM