Emergency Contact Form

Emergency Contact Form

Preschool and Early Intervention for Ulster County
Privacy Policies

For more information on the privacy policies of Jotform and Ulster County please click on the following:

Jotform Privacy Policy
Jotform Security
Ulster County Privacy Policy
Ulster County Notice of Privacy Practices
For the safety of your child, Ulster County requires a minimum of two (2) emergency contacts to whom we may release your child in case we are unable to reach you in an emergency or in case you are unable to meet the bus. Emergency contacts must have transportation and must be sixteen (16) or older and must have a physical, valid form of photo identification (i.e., school/work/state ID, passport, driver’s license, etc.) to present in order to receive your child from the bus. The police department will be notified as a last resort.
Child's Name

First NameLast Name
Parent/Guardian's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com