Compass Emergency Card Update

763-381-1616 Con,passCoonRa pids.con,
Compass Location*
Enrollment Agreement

All fields must be completed per State Requirements.
Child's Full Name:*
First and Last Name
Child's Full Name Cover page
Child's Full Name Emergency 1
Child's Full Name Emergency 2
Nickname:
Nickname Emergency 1
Nickname Emergency 2
Date of Birth:*

MonthDayYear
Or Due Date
Date of Birth Cover Page

MonthDayYear
Date
Date of Birth:

MonthDayYear
Date
Date of Birth:

MonthDayYear
Date
Gender:*
TBD for unborn child
Gender EC 1
Gender EC 2
Parent/Guardian Information

Parent 1
Parent 1 Name:*
Parent 1 Work Phone:
Parent 1 Cell Phone:
Parent 1 Email:*
example@example.com
Parent 1 EC1
Parent 1 EC2
Parent/Guardian Information

Parent 2
Parent 2 Name:
Parent 2 Work Phone:
Parent 2 Cell Phone:
Parent 2 Email:
example@example.com
Parent 2 EC1
Parent 2 EC2
Parent 1 Work Phone EC1
Parent 1 Work Phone EC2
Parent 2 Work Phone EC1
Parent 1 Cell EC1
Parent 1 Cell EC2
Parent 2 Cell EC1
Parent 1 Email EC1
Parent 1 Email EC2
Parent 2 Email EC1
Parent 2 Email EC2
Emergency Contact Information:
For the protection of your child, please list below the names and phone number of those persons you authorize to pick up your child from Compass. Emergency contacts must be friends or other family members who do not live with you and are familiar with your child. Compass will only release your child to adults you designate as authorized. It is our policy to ask all unfamiliar adults for photo identification. Please notify the Teacher and Director if someone other than the primary or secondary parent/guardian will be picking up your child on a given day. If they are not listed and/or they do not have identification your child will not be released. You may adjust this list at any time.
Emergency Contact 1

Emergency contacts must be friends or other family members who do not live with you and are familiar with your child.
Emergency Contact 1 (cannot be either parent):
Emergency Contact 1
Emergency Name 1 EC1
Emergency Name 1 EC2
Phone:
Relationship to Child:
Relationship to Child 1 EC1
Relationship to Child 2 EC1
Emergency Phone 1 EC1
Emergency Contact 2 Phone EC1
Emergency Contact 2 Relationship EC2
Parent 2 Cell EC2
Parent 2 Work Phone EC2
Emergency Phone 1 EC2
Emergency Phone 2 EC2
Emergency Relationship 1 EC2
Emergency Contact 2
Emergency Contact 2 (cannot be either parent):
Emergency Contact 2
Emergency Contact 2 EC1
Emergency Contact 2 EC2
Phone:
Relationship to Child:
Should be Empty:

Enrollment Agreement

Parent/Guardian Information

Parent/Guardian Information

Emergency Contact Information:

Emergency Contact 1

Emergency Contact 2