Emergency Contact info

Roamin’ with Roman Emergency Contact/Allergy/Medical Information

Please provide us with a reliable contact person in the unlikely event of an emergency.

 

Contact name: _______________________________________________________________________________

 

Relation: _____________________________________________________________________________________

 

Contact Phone: ______________________________________________________________________________

 

2nd Phone: ___________________________________________________________________________________

 

 

2nd contact name: ___________________________________________________________________________

 

Relation: _____________________________________________________________________________________

 

Contact Phone: ______________________________________________________________________________

 

2nd Phone: ___________________________________________________________________________________

Please list any allergies that you would like us to be aware of:

 

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***Please list any medications you are currently taking as well as existing medical history.  To protect your privacy, you do not need to return this form to me but should keep it in your luggage during the trip in a sealed envelope.  Remember to label the envelope medical history! In case of emergency, we will be able to find it and provide it to the medical staff. ***

 

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