Emergency contacts 2006-2007
 
Child's name: Child's first name:
Grade:
Address:
e-mail (secondary school students):
Please indicate below the person to contact in case of an emergency for your child, and, if applicable, allergy details.
1st primary caregiver:

Name: 

 Firstname:
Relationship to child:
Daytime phone number:
Please indicate whether this is office or home
Alternate phone number:
Please indicate whether this is office or home
Mobile:
e-mail:
2nd primary caregiver:

Name: 

 Firstname:
Relationship to child:
Daytime phone number:
Please indicate whether this is office or home
Alternate phone number:
Please indicate whether this is office or home
Mobile:
e-mail:
Other emergency contact:

Name: 

 Firstname:
Relationship to child:
Daytime phone number:
Please indicate whether this is office or home
Alternate phone number:
Please indicate whether this is office or home
Mobile:
Allergy details (if any):





 
Date completed: Name and signature: