TCA | Emergency Contact Form

Trinity Christian Academy

Emergency Information Sheet | 2026/2027 Academic Year
Please complete the following as soon as possible. Be sure everything is accurate and legible. Please notify the school office of any changes to this information. Thank You.
Student Name

First NameLast Name
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Numbers
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email (This would be used to inform you of events, child's progress, etc.)
example@example.com
If in the event of an emergency you cannot be reached, please list a contact
person that we could notify:
Name of Contact Person:

First NameLast Name
Phone Numbers of Contact Person
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship of Contact Person to Student (relative, friend of family, etc.)
Medical Information
Name of Students Physician

First NameLast Name
Physicians Office Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Students Dentist

First NameLast Name
Dentist Office Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list any allergies your child has:
Please list any medications your child is currently taking:
Please feel free to list any additional information that you feel would be prudent in an emergency situation concerning your child:
Student Pick-Up Authorization
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Trinity Christian Academy

Phone Numbers

Phone Numbers of Contact Person

Medical Information

Student Pick-Up Authorization