Staff Contact Information

Staff Information
Name*
First Last
Student Number*
Program, Year*
Example: Aerospace, 2
T-shirt Size*
AS = Adult Small etc.
Cell Phone Number*
Health Card Number (Optional)
Allergies/Medical Conditions
Medication
Emergency Contact 1:
Name*
First Last
Relationship to you*
Home Phone Number*
Cell Phone Number
Work Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact 2:
Name*
First Last
Relationship to you*
Home Phone Number*
Cell Phone Number
Work Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Staff Information