Emergency Contact Form

Address
Birthday
Student Name
Age
Email
example@example.com
Cell
Parent 1 Name
Work
Email
example@example.com
Cell
Parent 2 Name
Work
In case of an emergency who should we contact first
If parents are not available, what other individuals should be contacted?
Name
Relationship to Child
Phone Number
What individuals can pick-up your child from school in case of an emergency? Include Name/Phone #
1
3
2
If your child is injured which hospital should we take your child
Any special medical information including allergies medications etc
Should be Empty: