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Emergency Information Sheet 2023-2024
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* Indicates required question
Student (Last Name, First)
*
Your answer
Student Grade
*
Choose
K
1
2
3
4
5
6
7
8
Address
*
Your answer
Parent/Guardian #1 Information
Parent #1 Name
*
Your answer
Parent #1 Relationship to Student
*
mother
father
legal guardian
Other:
Parent #1 Cell Phone
*
Your answer
Parent #1 Work Phone
Your answer
Parent #1 Email Address
*
Your answer
Parent/Guardian #2 Information
Parent #2 Name
Your answer
Parent #2 Relationship to Student
mother
father
legal guardian
Other:
Clear selection
Parent #2 Cell Phone
Your answer
Parent #2 Work Phone
Your answer
Parent #2 Email Address
Your answer
Emergency Contact Information
In an emergency, if the parents/guardians cannot be reached, who should the school contact?
Emergency Contact #1 Name
Your answer
Emergency Contact #1 Relationship to Student
Your answer
Emergency Contact #1 Cell Phone Number
Your answer
Emergency Contact #1 Work Phone Number
Your answer
Emergency Contact #1 Home Phone Number
Your answer
Emergency Contact #2 Name
Your answer
Emergency Contact #2 Relationship to Student
Your answer
Emergency Contact #2 Cell Phone Number
Your answer
Emergency Contact #2 Work Phone Number
Your answer
Emergency Contact #2 Home Phone Number
Your answer
Please indicate names of all persons who have your permission to pick up your child from school. Include neighbors, relatives, etc.
*
Your answer
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