Emergency Contact Form
An emergency contact form tells a school, employer, gym, or landlord whom to call if you are hurt or cannot speak. It is not a medical power of attorney and it does not let that person make treatment decisions. Doctors still follow their own consent rules. What this page does well is put two reachable people, a doctor, and the allergies that matter on a single sheet someone can read in a hurry.
For any adult, and the parent who is filling it out for a household. When: on the first day of a job, a membership, a lease, or a trip where someone else may have to call for you.
Naming a state changes the note on the page. It does not add that state's required clauses, fees, or font rules. Papero does not invent statutes.
15 lines are still blank. You can still print. Write "not applicable" on a line that does not apply.
Leaving this page clears what you typed. Papero does not save it. On a shared computer, press Clear before you walk away.
Preview. This is the page that prints.
Emergency Contact Form
Person
First contact
Second contact
Medical
Signature
Signature
Date
Why this form exists, and what it will not do
Emergency Contact Form is for any adult, and the parent who is filling it out for a household. The moment to use it: on the first day of a job, a membership, a lease, or a trip where someone else may have to call for you. It sits in the Personal group on Papero. Contact sheets, budgets, inventories, and statements you keep or hand to an office.
Fill it in this browser. Papero does not create an account, does not upload the answers, and does not keep a copy after you close the tab. When the preview looks right, print it or download a PDF. The PDF is built on your device. A blank download leaves the lines empty so someone else can fill them by hand.
Work through the page in order. The Person section asks for Full name, Date of birth, Mobile phone, Home address. The First contact section asks for Contact name, Relationship, Phone, Second phone. The Second contact section asks for Contact name, Relationship, Phone. The Medical section asks for Primary doctor, Doctor phone, Allergies, Conditions a responder should know.
Full name. The person this sheet is about. Date of birth. Used so two people with the same name are not mixed up. Mobile phone. Your own number. Home address. Street, city, and state where you live now. Contact name. The first person to call. Relationship. How they know you. Phone. A number that works at night. Second phone. A backup. Write "none" if there is no second line.
Contact name. A different household than the first contact, if you can. Relationship. How they know you. Phone. Direct number. Primary doctor. Name of the clinic or physician. Doctor phone. The after-hours line if you know it. Allergies. Medicines, foods, or latex. Write "none known" rather than leaving it blank. Conditions a responder should know. Only what a stranger with this paper needs in the first hour.
People send this back, or refuse it, for ordinary reasons. Both contacts share one phone. The doctor line is a billing office. Allergies are left blank when there are allergies. Read the finished page once as if you were the person receiving it. If a line would make you call back, fill that line.
Sign on the Signature and Date line. A typed name in the signature spot is weaker than ink on a printed page. Date it the day you sign, not the day you hope the other person signs.
What this page cannot do: This is a personal template. An office, school, or landlord that gives you its own form expects that form. A bank or a government desk that asks for a full Social Security number should collect it on its own secure form. Papero asks for the last four digits only, on purpose. Papero is not a law firm, not a government agency, and not the office that will accept or reject the paper.
State note for your state. Emergency Contact Form does not contain your state's required clauses, font size, language, or filing fee. Counties and cities inside your state sometimes add their own rule on top of the state. Before you rely on this for a lease, a school, a court, a bank, or an agency, compare it with the form that office publishes. If the office has no form, this template is a clear record of what you wrote and what you signed on this date.
After you print, use dark ink. Write "not applicable" on a line that does not apply, so a clerk does not treat a blank as a missing fact. Initial a correction beside the line. Do not cover a dollar amount with correction fluid. Each person who has a signature line signs their own name. One person cannot sign for another unless a statutory power of attorney, on the form that office accepts, already says so. Give the other party a copy the same day. On your copy, note the date and whether you handed it over, mailed it, or uploaded it to their portal. Attach copies of supporting papers, not your only original, unless the office demanded the original. Do not attach a Social Security card, a passport image, or a bank statement unless the recipient told you to, and then only in person or through their secure portal. Email is a common way those images are stolen. If the recipient is a government office, stop and use the form on that office's own site. Papero does not transmit this page, does not notarize it, and does not store it.
Keep a copy. Give the other party a copy. If you later change a fact, fill the form again and date the new copy. Do not scribble a second story into the margin of a page someone already signed. Write the date you handed it over, and how, on your own copy.
Before you rely on it
- Both contacts share one phone.
- The doctor line is a billing office.
- Allergies are left blank when there are allergies.
This is a personal template. An office, school, or landlord that gives you its own form expects that form. A bank or a government desk that asks for a full Social Security number should collect it on its own secure form. Papero asks for the last four digits only, on purpose.
How to fill and print it
- Fill the lines. Type into the Emergency Contact Form in this browser. Write "not applicable" on a line that does not apply. What you type stays in this tab and is not uploaded.
- Check the preview. The boxed preview is the page that prints. Read it once as the person who will receive the paper.
- Print or download. Use Print, or download a filled PDF or a blank PDF. The file is built on your device.
More Personal forms
Questions
What is a Emergency Contact Form used for?
An emergency contact form tells a school, employer, gym, or landlord whom to call if you are hurt or cannot speak.
Who should use this Emergency Contact Form?
It is for any adult, and the parent who is filling it out for a household. Use it when on the first day of a job, a membership, a lease, or a trip where someone else may have to call for you.
Does this Emergency Contact Form need a notary?
No. This Emergency Contact Form has no notary block. Sign the Signature, Date line in ink on the printed page if you are handing it to someone.
Will a Emergency Contact Form from Papero be accepted?
Both contacts share one phone. This is a personal template. An office, school, or landlord that gives you its own form expects that form. A bank or a government desk that asks for a full Social Security number should collect it on its own secure form. Papero asks for the last four digits only, on purpose.
What gets a Emergency Contact Form sent back?
Both contacts share one phone. The doctor line is a billing office. Allergies are left blank when there are allergies.