NS Emergency Contact Form

St. Paul's Nursery School Emergency Contact/Parental Consent Form 2024-25

Child's Name(Required)

First Last

Birthday(Required)

Home Phone(Required)

Address(Required)

First guardians name(Required)

First Last

Work Phone(Required)

Work Address(Required)

Home Address (if different than child's)

Email(Required)

Cell Phone(Required)

Second Guardians Name(Required)

First Last

Work Phone(Required)

Work Address(Required)

Home address(if different than child's)

Email(Required)

Cell Phone(Required)

Physician Name(Required)

Last

Phone(Required)

Physician's Address(Required)

Allergies(Required)

Special Disabilities (IEP/IFSD)(Required)

Health Insurance and Policy Number(Required)

Parent Signature for obtaining Emergency Medical Care(Required)

Parent Signature for administering Minor First Aid(Required)

Parent Signature for Emergency Transportation(Required)

Parent Signature for Class walks and trips(Required)

September Parent Signature(Required)

Date(Required)

February Review Signature

Date