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Emergency Contact

Student Information

State*
Answer Required

Mother / Guardian Information

Father / Guardian Information

Emergency Contact Information

List below names of three additional people who may be called in case of emergency or if child is sick in school. CHILD WILL BE RELEASED ONLY TO PEOPLE NAMED ON THIS CARD.

Emergency Contact 2

Emergency Contact 3

Medical Information

Please click on the link below to download a hard copy of this form. This form will allow you to provide the school with medical information (e.g., allergies, medical insurance).  Complete the form and give it to the Pupil Accountant Secretary.