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Emergency Contact Information
For your Protection Only

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Leadership Pasadena is voluntary and involves participation in sessions and other events, travel to and from session locations, and other activities designed to enhance the experience of the participant.

Medical Emergency Process

In the event of an emergency, Leadership Pasadena will follow the designated procedures of the third party site location that is hosting the particular session or activity. In the event of a medical emergency, Leadership Pasadena will contact emergency medical authorities via the 911 emergency response system.

Every effort will be made by Leadership Pasadena to contact the individuals you indicated as emergency contacts. If you have any additional steps you would like Leadership Pasadena to undertake in the event of a medical emergency involving you, please let us know in the space below:

The following information is voluntarily asked for to allow us to help you quickly and in the way you wish in case of a medical incident. This is OPTIONAL. We do not ask for any medical information. Please be aware of Health Insurance Portability and Accountability Act privacy rules and consult your personal attorney if you are concerned in any way about answering any of these questions.

Again, they are VOLUNTARY AND OPTIONAL and have no bearing on your participation in the Leadership Pasadena program.

This document may be signed digitally, and this digital signature shall be binding as if executed with an original signature been affixed hereto.


First Name
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First Name
Last Name




First Name
Last Name




First Name
Last Name