Emergency Card 2026
Parks & Recreation Part-Time Employees
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Assignment
*
Please Select
Administrative Support (Supervisor: Jamie Tun)
SAVES (Supervisor: Patricia Morales/Hilda Meraz)
Recreation Centers/Legacy Commons/Parks (Supervisor: Laura Rice)
Sports (Supervisor: Ryan Herman)
Aquatics (Supervisor: Jacki Nuss)
DryTown (Supervisor: Juan Ledezma)
Special Events (Supervisor: Issac Beas Bautista/ Doug Berrios)
Palmdale Playhouse (Supervisor: Alice Cowan)
Public Art (Supervisor: George Davis)
If you are not sure, please ask your supervisor before submitting this form.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Title
*
Department
*
Please Select
Parks & Recreation
Driver's License No
Birthdate
*
Doctor
Doctor's Name
Doctor's Phone
Doctor's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact #1
In case of emergency, please notify:
1. Full Name
*
Phone
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation
*
Additional Numbers
Emergency Contact #2
In case of emergency, please notify:
2. Full Name
*
Phone
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation
*
Additional Numbers
Submit
Should be Empty: