Please fill out the attached
emergency information sheet. Please print clearly.
SAINTS PETER AND PAUL BEFORE AND
AFTER SCHOOL
Emergency Form 2007-2008
Grade____
Student
Name________________________________________________ DOB____________________
Address_____________________________________________________ City___________________ Zip____
Parent/Guardian Information
Mother Father
Name_____________________________________Name____________________________Address__________________________________ Address_________________________
Home Ph #______________________________ Home Ph#_________________________ Employer_______________________________ Employer________________________
Address_________________________________ Address_____________________________
City_____________________ St.____ Zip_______City_________________ St. ___Zip____
Work# w/area code_______________________Work# w/area code_____________________
Cell Ph#_____________________________ CellPh#_____________________________
Child lives With ___Both Parents ___Mother ___Father ___Other
If
there is someone other than the parent/guardian who may be picking up your
child/children, please put their names & relationship to the child/children
here: _________________________________________________________________________
If there are persons who may not pick up your child/children, please put their name & relationship to the child here:
________________________________________________________________________
Does your child have any food or other allergies & does he/she take medications for these allergies?
EMERGENCY CONTACTS (other than parents)
1.Name__________________________ Relationship_______________
Address_________________________ City__________ St. ___ Zip_____
Home#_______________Work #________________Cell Ph#_______________
2.Name___________________________Relationship______________
Address__________________________ City__________ St. ___ Zip____
Home #___________________Work #______________Cell Ph#_______________
3. Name __________________________ Relationship_______________
Address_________________________ City__________ St. ___ Zip_____
Home #________________Work #_______________Cell Ph#_______________
ALL
STUDENTS MUST HAVE 3 EMERGENCY CONTACTS OTHER THAN PARENTS