Emergency Contact Card 2022-2023
Dear Parents and Guardians,

Please take a few minutes to complete the Emergency Contact Card for your child for the 2022-2023 School Year. If you have multiple children enrolled at PS 56, please complete a SEPARATE form for EACH child.

If you need any support with completing the contact card, please reach out to your child's teacher or our Parent Coordinator, Lina Cardenas, Lcardenas3@schools.nyc.gov.

Thank You,

Principal Gitli
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Email *
Student Last Name *
Student First Name *
Student Middle Initial:
Student Date of Birth *
MM
/
DD
/
YYYY
Sex *
Student ID # (If unsure, please skip and go to the next question)
Student Grade for 2022-2023 *
Student Class Number (If unsure, please skip and go to the next question)
Student's Teacher (If unsure, please skip and go to the next question)
Parent/Guardian (Student resides with) Full Name *
Parent/Guardian Relationship to Student *
Parent's Written Preferred Language of Communication
Clear selection
Parent's Oral Preferred Language of Communication
Clear selection
Home Telephone Number  (xxx-xxx-xxxx) *
Work Telephone Number (xxx-xxx-xxxx)
Cell Phone Number (xxx-xxx-xxxx) *
Address *
Borough *
Zip Code *
Please enter information below for your child's other parent or guardian.
Other Parent/Guardian Full Name
Relationship to Student
Clear selection
Parent's Written Preferred Language of Communication
Clear selection
Parent's Oral Preferred Language of Communication
Clear selection
Home Telephone Number (xxx-xxx-xxxx)
Work Telephone Number (xxx-xxx-xxxx)
Cell Phone Number (xxx-xxx-xxxx)
Email Address
Address
Borough
Clear selection
Zip Code
List below names of at least (2) persons who may be called in case of emergency or if your child is sick in school. YOUR CHILD WILL BE RELEASED ONLY TO PERSONS NAMED ON THIS CARD.
Name of Person 1
Telephone Number
Relationship to Student
Name of Person 2
Telephone Number
Relationship to Student
Name of Person 3
Telephone Number
Relationship to Student
If there is a person who MAY NOT HAVE ACCESS  to your child, please indicate that person below
Name of person who may not have access to your child
Relationship to Student
Does an Order of Protection Exist?
Clear selection
Electronic Signature
Next
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