Emergency Card Form

To serve your child in case of accident or sudden illness, it is necessary that you give the following information for EMERGENCY CALLS.

Emergency Card Form

Step 1 of 2

50%
  • Parent/Guardian (Primary Contact)

  • Parent/Guardian (Secondary Contact)

  • List two neighbors or nearby relatives who will assume temporary care of your child(ren) If you cannot be reached:

  • List any medical/surgical care your child has received during the past year:

  • Please state what kind and list medication.
  • Please enter date and list medication.
  • Please enter date and list type.
  • Please list type.