Please complete this form with ALL information
In the case of accident, illness, or other emergency, school principals must be able to locate the parent or some other person who will care for the child. We must have on file the names and phone numbers of two other persons who may be called to pick-up the child if the parents cannot be reached. Please provide the information requested below and then return this form to the school promptly. Thank you for your cooperation.

IMPORTANT: Prior to completing this form, please make sure you have all emergency contact information with you as well as physician contact information.