Emergency Contact Form - Child

  • Emergency Contact Information for:

  • Primary Emergency Contact Information

  • Alternative Emergency Contact (Local)

  • Out of State Emergency Contact

    We ask for this information in case of a power outage or other issue that might disrupt local phone service. We will attempt to contact this individual via a landline.
  • Medical Information

  • Please put NONE if child does not have any allergies or special health conditions.
  • Please put NONE if child does not take any medications.