LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Emergency Contact Form Dat 09/10/18 Start Date: 08/26/2018 ate: /10/ _ Employee Name: Stephanie Remington 8-1-3 Estate Smith Bay 00802 irth: Address: (3 eo Date of Birth: Title / Position: Asst to Manager Marital Status: Single License: a | Allergies or Health Concerns: Blood Type: a es ton: ee Doctor's Name: _isiand Health & Wellness Center rrone Doctor's Name: Phone: In case of an Emergency, Please contact : Name Ft Relationship Frend Phone Bone a ctetorditp Sen — This Information is for your safety and the safety of others EFTA00003069