Emergency Contact Information

We created this Emergency Contact form for our instructors, artists and interns. This form will give us the information we need regarding the individual that should be contacted in the event of an emergency.

All entries are confidential and information provided will be used for emergency and other applicable purposes only.

Please fill out the form below

Your Name

First Name

Last Name

What CAC program are you most involved with?

CAC Adult Instructor

CAC Community Arts Instructor

CAC Artist

Independent Study Artist

Work Exchange

Resident Artist

Intern

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Email

Your Phone

(###)

###

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Anything else you would like CAC to know?

Example: relevant health conditions

Emergency Contact

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

example: sibling, partner, parent

Emergency Contact Phone Number

(###)

###

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