Submit Emergency Contact Information

Emergency Contact Information

Please fill out one form for each person working at the Market.

Your name:

CONTACT #1

Name:

Relationship:

Home Phone:

Cell Phone:

CONTACT #2

Name:

Relationship:

Home Phone:

Cell Phone:

CONTACT #3

Name:

Relationship:

Home Phone:

Cell Phone:

Primary Medical Facility/Provider:

Do you have any known allergies or medical conditions that we should be aware of?

I have voluntarily provided the above contact information and authorize the Mankato Farmer’s Market and its representatives to contact any of the above on my behalf in the event of a medical emergency.

I choose not to furnish any emergency contact information to the Mankato Farmer’s Market at this time.

Please provide any additional documents you feel we need.

By clicking submit below, I agree to the conditions stated above and that all information I have stated on this form is correct. This information is to be kept in the Market Manager’s Shed and will be classified as confidential.