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Friends: please enter your emergency contact information in this form which will register with our office so that if there’s any need, we can easily get in touch with your loved ones. This is not for your doctors or others–you would leave that information with your emergency contact. We will reach out to them and then they would be your decision-maker on your behalf.

If you and your spouse have different emergency contacts, please fill out this form twice, once for each of you.

Holy Land Emergency Contact

Emergency Contact for the period of Feb 20-Mar 5, 2018.
  • Only enter a name under 'Spouse Name' if you both have the same emergency contact person. If you have different emergency contacts, please leave this field blank and submit two separate forms. Thank you.