Hawk Premier Painting LLC

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Crew emergency contact information

Tell us who to contact if you need help at work. Submit directly to Lonnie and Debbie, with a copy to AJ Samuel—no email app needed. Fields marked * are required.

Your contact information

Full name *Mobile phone *Email address (optional)Crew or work location (optional)

Primary emergency contact

Contact name *Relationship to you *Phone number *Alternate phone number (optional)

Backup emergency contact (optional)

Contact name (optional)Relationship to you (optional)Phone number (optional)

Information for emergency assistance (optional)

Share only what you want Lonnie and Debbie, with a copy to AJ Samuel to know to help during an emergency, such as a serious allergy, the location of emergency medication, or assistance you may need. You can leave this blank or speak with them privately. Do not include your Social Security number, insurance details, full medical history, or family medical history.

Emergency assistance notes (optional)

I confirm these details are accurate and my emergency contacts know I have listed them. I agree to have this information, including any optional emergency notes, saved by Hawk Premier Painting for referral and emergency-planning support and emailed to Lonnie and Debbie, with a copy to AJ Samuel. *

This form is for crew emergency records. For an immediate emergency, call 911.