Student Emergency Information
Emergency Contacts: In an emergency that requires the school to release student using parent/child reunification protocols, and when parents/ guardians and other responsible adult(s) already listed cannot be reached, the school may release the student to these individuals Emergency Contact #1: (Last, First) Relationship to Student
Student Emergency Contact Form
Student Emergency Contact Form Personal Information First Name Last Name Student ID# Home Address Address (Line 2) City State ZIP Code Home Phone Cell Phone E-mail Date of Birth Emergency Contact First Name Last Name Relationship Home Phone Cell Phone Work Phone E-mail Secondary Emergency Contact-(if 1st Emergency Contact is not
Emergency Contact Information and Authorization for Release
Emergency Contact Information and Authorization for Release of Student from School: 1 PRINT all information 2 INCLUDE EACH PARENT/GUARDIAN/SURROGATE ON THIS LIST Circle the appropriate relationship to student 3 List all contacts who may act on your behalf in case of sudden illness, accident, or emergency 4
For Office Use Only: Student Emergency Contact Card School
Student Emergency Contact Card In the case of an emergency, it is imperative that the school be able to reach the student's parent (as defined below) Please fill in the information on both sides of this card carefully and accurately Please use ink and print clearly The names of both parents of a student (as defined in the Section 1000 21(5
STUDENT INFORMATION: EMERGENCY CONTACT INFORMATION: ALLERGIES
An emergency medical plan of action to follow in the event of an accident/emergency should accompany this form • 911 Policy: In all cases and circumstances, River Tree Arts will call 911 and the staff will abide by and follow all EMS/911 instructions during a medical emergency concerning the above mentioned student
Emergency Student Information - ocpsnet
Emergency Student Information Form Emergency Contact Form OCPS1069Stu(revised 7/08) Page 1 of 2 Emergency Information-English STUDENT INFORMATION PHYSICIAN INFORMATION Doctor’s Name Dentist’s Name Preferred Hospital
PARENT/GUARDIAN CONTACT INFORMATION
EMERGENCY CARE INFORMATION In case of an emergency, the school staff will contact 911 Every attempt will be made to contact a parent, a guardian, or a designated emergency contact F Last: First: Date of Birth:Middle: Gender: Grade: Bus # (AM): Bus # (PM): M STUDENT INFORMATION Student has medical alert information on file See page 2 for details
AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT
Parent Information: Please fill out completely and sign where indicated In a major emergency, it is school district policy to retain students at school for their safety This form will be used by the school staff when students are released to go home
Updating Emergency Information in Student Self Service 9 24 15
West Texas A &M University Updating Emergency Contact Information on Student Self Service In the bottom section, provide any additional medical information that could be important for the university to know in an emergency Once you are done, click “Confirm” on the top portion of the page You will get a confirmation message in the header (top
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