Emergency Contact Update Form

Dear Parent/Guardian,

Please help us ensure that we have the correct Emergency Contact and Pick Up information for your child. You may use this form for all enrolled children or submit separate forms if you have different contacts or permissions for each child. For each contact, please provide a full name, relationship to student, phone number and check the box under each role or permission that applies (i.e. authorized to pick up, emergency contact, NOT permitted to pick up your child).

Thank You,
Main Office
Student 1 Name*
Student 1 Grade*
Student 2 Name
Student 2 Grade
Student 3 Name
Student 3 Grade
Emergency Contact and Pick-Up Information
1) Name of Individual [1]

First NameLast Name
Relationship to Student [1]
Phone Number [1]
Please enter a valid phone number.
Yes, this person is authorized to Pick Up my student
Yes, this person may be contacted in an emergency in case I am unable to be reached
Yes, this person is NOT permitted to Pick Up my student
- 2) Name of Individual [2]
  
  First NameLast Name
- Relationship to Student [2]
- Phone Number [2]
  Please enter a valid phone number.
- Yes, this person is authorized to Pick Up my student
- Yes, this person may be contacted in an emergency in case I am unable to be reached
- Yes, this person is NOT permitted to Pick Up my student
- 3) Name of Individual [3]
  
  First NameLast Name
- Relationship to Student [3]
- Phone Number [3]
  Please enter a valid phone number.
- Yes, this person is authorized to Pick Up my student
- Yes, this person may be contacted in an emergency in case I am unable to be reached
- Yes, this person is NOT permitted to Pick Up my student
- 4) Name of Individual [4]
  
  First NameLast Name
- Relationship to Student [4]
- Phone Number [4]
  Please enter a valid phone number.
- Yes, this person is authorized to Pick Up my student
- Yes, this person may be contacted in an emergency in case I am unable to be reached
- Yes, this person is NOT permitted to Pick Up my student
- 5) Name of Individual [5]
  
  First NameLast Name
- Relationship to Student [5]
- Phone Number [5]
  Please enter a valid phone number.
- Yes, this person is authorized to Pick Up my student
- Yes, this person may be contacted in an emergency in case I am unable to be reached
- Yes, this person is NOT permitted to Pick Up my student
- 6) Name of Individual [6]
  
  First NameLast Name
- Relationship to Student [6]
- Phone Number [6]
  Please enter a valid phone number.
- Yes, this person is authorized to Pick Up my student
- Yes, this person may be contacted in an emergency in case I am unable to be reached
- Yes, this person is NOT permitted to Pick Up my student