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EMERGENCY
CONTACT SHEET Student
name(s)_________________ __________________________ In
case of an emergency and the parent cannot be reached we need another
person(s) to contact for your child.
In case of a medical emergency the person should live in or close
by the Norwalk community.
Parents
cell phone numbers ____________________________________________________
Name
__________________________________________
Phone ___________________
Name
__________________________________________ Phone ___________________
Name
__________________________________________
Phone ___________________
Doctor
_____________________________________
Hospital_________________________________________________ Is there any medical information
we would need to give to medical personnel in case your child would
not be able to speak? (i.e.: allergies, medications,etc) You
have my permission to treat my child for injury. ______________________________________ Parent signature date |