2023-2024 HOLY FAMILY SCHOOL EMERGENCY CARD

HOLY FAMILY SCHOOL EMERGENCY CARD
Student #1 Name*

First NameLast Name
Student #2 Name

First NameLast Name
Student #3 Name

First NameLast Name
Student #4 Name

First NameLast Name
Mother/Guardian's Name

First NameLast Name
Mother/Guardian's Cell Phone

Area CodePhone Number
Father/Guardian's Name

First NameLast Name
Father/Guardian's Cell Phone

Area CodePhone Number
Name and Number to call first:
In the case of an accident or serious illness, if Holy Family School is unable to contact me, I hereby authorize the school to contact 911 to take my child to the hospital designated below.
Hospital Choice:
Parent/Guardian Name

First NameLast Name
Parent Signature
1) Name of person, other than parents, to be notified in an emergency or to whom the child may be released:

First NameLast Name
1) Phone Number

Area CodePhone Number
2) Name of person, other than parents, to be notified in an emergency or to whom the child may be released:

First NameLast Name
2) Phone Number

Area CodePhone Number
3) Name of person, other than parents, to be notified in an emergency or to whom the child may be released:

First NameLast Name
3) Phone Number

Area CodePhone Number
Should be Empty: