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Student Emergency Contact Information
Please complete the following information for your child.
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* Indicates required question
Child's LAST name
*
Your answer
Child's FIRST name
*
Your answer
Parent/Guardian #1 Name
*
Your answer
Parent/Guardian #1 Cell Phone
*
Your answer
Parent/Guardian #2 Name
Your answer
Parent/Guardian #2 Cell Phone
Your answer
Alternate Contact Information - In the event of an emergency, we will make every effort to contact the person(s) listed above. If not reachable, we will call the following Emergency Contact - NAME
*
Your answer
Emergency Contact Cell Phone
*
Your answer
If the emergency contact cannot be reached, my child(ren):
*
has permission to walk home.
has permission to take the bus.
will be picked up by your Emergency Contact Person listed above
Required
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