Bushfire Emergency Information
Name of Student
Firstname Lastname
Year Level
Eg: 9
Is your home in a bushfire risk area?
Yes
No
Does your daughter(s) travel after school through a bushfire risk area?
Yes
No
If yes, please indicate which, if any, of the following routes are used after school
Belair Road
Montacute Road
Gorge Road
Mt Barker Road
Grand Junction Road
Norton Summit Road
Greenhill Road
Port Wakefield Road
Lower North East Road
South Road
Main North East Road
Other
Main North Road
Any other relevant details
Alternative Accommodation:
Name of contact person
Phone
Format: (000) 000-0000.
Relationship to student
Address:
Printed name
Date
/
Day
/
Month
Year
Date
Submit
Should be Empty: