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Emergency Contact Form (Update)
In order to provide a safe environment for students as we return to in-person learning, we must ensure that our information for students is current in case of an emergency.
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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Current Address
*
Your answer
Parent #1 Full Name
*
Your answer
Parent #1 Cell Phone Number
*
Your answer
Email Address
Your answer
Parent #2 Full Name
Your answer
Parent #2 Cell Phone Number
Your answer
Mode of transportation to school
Bus (only)
Car Rider (only)
Walker
AM Car Rider/PM Bus
AM Bus/ PM Car Rider
Other:
Clear selection
Person authorized to pick up student (full name)#1
*
Your answer
Cell Phone Number
*
Your answer
Relationship to student
*
Grandparent
Sibling
Step-Parent
Aunt/Uncle
Other:
Person authorized to pick up student (full name)#2
Your answer
Cell Phone Number
Your answer
Relationship to student
Grandparent
Sibling
Step-Parent
Aunt/Uncle
Other:
Clear selection
Person authorized to pick up student (full name)#3
Your answer
Cell Phone Number
Your answer
Relationship to student
Grandparent
Sibling
Step-Parent
Aunt/Uncle
Other:
Clear selection
Person authorized to pick up student (full name)#4
Your answer
Cell Phone Number
Your answer
Relationship to student
Grandparent
Sibling
Step-Parent
Aunt/Uncle
Other:
Clear selection
Person authorized to pick up student (full name)#5
Your answer
Cell Phone Number
Your answer
Relationship to student
Grandparent
Sibling
Step-Parent
Aunt/Uncle
Other:
Clear selection
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