Emergency Preparedness
Dear Parents,
The following information is needed for each classroom's Emergency Preparedness Kit. One form must be completed for each student. Space has been provided for you to list those people to whom the school may release your child in the event of an emergency situation. Please return these forms with your child on the first day of school.
Student's name ________________________________ Age ____ Grade _____________
Home Address ___________________________________________________________
___________________________________________________________
Home telephone (include area code) ___________________________________________
Business phone - Mother ___________________________________________________
Father ___________________________________________________
Any additional (cell phone, pager, etc) _________________________________________
In case of an "Emergency" my child may be released to the following:
Father _______________________ Phone ____________________________________
Mother ______________________ Phone ____________________________________
Others:
Name: _______________________ Phone ____________________________________
Name: _______________________ Phone ____________________________________
Name: _______________________ Phone ____________________________________
Out of area contact:
Name: _______________________ Phone ____________________________________
Parent Signature : ________________________________________ Date ____________