CMIT SOUTH ES - EMERGENCY CONTACT INFORMATION
This information is required for school staff to follow the correct procedures and make appropriate contacts in case of emergency.
This includes the unscheduled closing of schools, illness of student, accident, or other situations in which someone other than the parent/guardian needs to assume temporary care of your child if you cannot be reached.

Please ensure that the information you provide is correct. For questions that don't apply to your student put N/A.
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Email *
1. Student ID *
2. Student Name *
3. Birthdate *
4. Grade *
5. Food Allergies *
6. Health Concerns *
7. Mother/Guardian *
A. Phone number *
B. Email Address *
8. Father/Guardian *
A. Phone Number *
B. Email Address *
9. If, in the case of an emergency, a parent or guardian is unable to pick up my student the following people have my permission to pick up my child. Please indicate the relationship with the student. (The designated person should not be the mother/father and MUST show picture identification at the time of pick up). *
10. Parent/ Guardian Signature (Your name will serve as your signature) *
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