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 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 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
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
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 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
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
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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Student emergency contact procedure v 2
the University informing a nominated emergency contact if there is serious concern about the student’s welfare This guidance sets out the circumstances in which we may inform the emergency contact based on the student’s consent 2 3 Every student is an individual and their personal circumstances at
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Use of Student Emergency Contact Information
Students should ensure that the emergency contact is prepared to be an emergency contact and has given permission for their contact details to be provided to the University and used in line with this policy 4 Emergency contacts will not normally be updated about academic progress or any other aspect of the student’s life at University Contact details will be only be used in exceptional circumstances
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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 local) First Name Last Name Taille du fichier : 46KB
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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 StudentTaille du fichier : 854KB
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STUDENT EMERGENCY CONTACT INFORMATION
STUDENT EMERGENCY CONTACT INFORMATION Employee Name: _____ Address: _____ City: _____ State: _____ Zip: _____ Home Phone Number: _____ Cell Phone Number: _____
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STUDENT INFORMATION: EMERGENCY CONTACT INFORMATION
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 The Parent/Guardian will be notified by River Tree Arts staff at the
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Emergency Contact Information and Authorization for
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 List names in the order they should be contacted
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Emergency Student Information - ocpsnet
In the event of a serious accident or illness and I cannot be reached, I hereby authorize the school to contact the physician or dentist and for those professionals to provide protected health information In the event of an EMERGENCY, I understand that the school will access the 911 emergency medical system immediately To expedite care I
Student Emergency Contact Form Personal Information First Name Last Name Student ID# Home Address Address (Line 2) City State ZIP Code
Emergency Information
Student Emergency Contact Card For office use only: This form shall be updated every year Broward County Public Schools School # Medical Court Order
StudentEmergencyCard
Zip Subdivision Address City Date of Birth: Primary Phone #: Parent E-mail: Relationship Person to Call in Emergency (in order) Daytime # Cell # Student:
Student Emergency Contact Information Secondary
Student Emergency Contact Form. Personal Information. First Name. Last Name. Student ID#. Home Address. Address (Line 2). City. State. ZIP Code. Home Phone.
o Do Not Release Contact Information to Military Recruiters. Emergency Contacts: In an emergency that requires the school to release student using ...
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
EMERGENCY CONTACT CARD. SCHOOL YEAR 20__ __ – 20 __ __. You can update your contact information online using your NYC Schools Account at schoolsaccount.nyc.
These people also have your permission to pick your child up from school during the school day. PARENT/GUARDIAN CONTACT INFORMATION. Student Cell. Page 2. F.
FORT BEND INDEPENDENT SCHOOL DISTRICT. STUDENT EMERGENCY CONTACT INFORMATION Person to Call in Emergency (in order). Daytime #. Cell #. Student:.
Emergency Contact Information Form. This information will be extremely important in the event of an accident or medical emergency.
Student Emergency Contact Card. For office use only: This form shall be updated every year. Broward County Public Schools. School #. Medical. Court Order.
Jun 16 2014 In a major emergency
enrollment and may enable the student to Parent/Guardian and Emergency Contact Information: Add extra contacts on additional page if needed.
Student Emergency Contact Form