Employee Information & Emergency Contact Location(Required) Frederick Boonsboro Both Locations Personal Information:Employee Name(Required) Preferred Name(Required) Pronouns Date of Birth(Required) Month Day Year Home Information:Home Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneEmergency ContactsPrimary Emergency ContactContact Name(Required) Relationship(Required) HomeWorkCellEmail Secondary Emergency ContactContact Name Relationship HomeWorkCellEmail Additional InformationFavorite Starbucks Drink Favorite Candy/Snack Dietary Restrictions/Preferences Allergies (Food, Medication, Insects, Etc.)sMedical Alert(s)Health Insurance Company Policy Number Is there anything else we should know about you?Consent(Required) I understand this information may be shared amongst staff in case of an emergency.Signature(Required)Date Month Day Year
