Family and Emergency Information 20/21
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Email *
Child's First Name *
Child's Last Name *
Child's Date of Birth *
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Child's Teacher Name *
Child's home address *
Father's Name ( First and Last Name)
Father's Phone Number
Mother's Name (First and Last Name)
Mother's Phone Number
Emergency Contact First/ Last Name, Relationship to child  and Phone Numbers (you may list up to 3) *
Physician's Name and Phone Number *
Dentist Name and Phone Number *
Allery and/or ongoing condition your child has and reaction it causes (if none type N/A) *
List of medications (if none type N/A) *
In the event my child is involved in an accident or becomes sick to the extent that he/she should not remain at the school, I understand that the mother/father/guardian will be notified immediately. If they cannot be reached the emergency contact listed on the sheet will be contacted. If the accident or illness is not of an emergency nature, the child will remain at school until arrangements can be made for his/her care. However, in the event the accident or illness seems so serve that an delay in contacting a parent prior to seeking medical help will be dangerous to the child. or in the event the child needs immediate medical attention and the parents cannot be contacted, the school principal has my permission to take the child to a doctor or clinic with the understanding that I will bear the financial responsibility for the transportation and treatment.   *
Please understand that if school is dismissed early due to an early release day, emergency event or inclement weather conditions, your child will be sent home in the manner in which they are normally dismissed. If you choose an alternate dismissal, please contact the school office directly to communicate that change no later than 3PM. Early release days are 10/7/20,12/9/20,2/17/21 and 5/5/21. *
Required
Name of siblings and teacher at Lansdowne
In case of an Early release or emergency dismissal I would like my child to go home: *
Parent/Guardian Full Name completing this form *
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