Superstars - Emergency Contact Form

EMERGENCY CONTACT INFORMATION

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 to your community.

Parents Cell Phone Numbers:

Secondary Contact Name:

Relationship:

Phone:

Secondary Contact Name:

Relationship:

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)