Emergency and Transportation Form

 

Emergency Contact/ Transportation

Child's Name:
In case of an Emergency contact:

Parents Name:
Parents Address:

Parents Telephone#:
If in need of medical attention, what hospital would you recommend your child to go to:

How will you child arrive to school?
   Day Care Van:
   Car Rider:

    Walker:

How will your child return home?
    Day Care Van:

    Care Rider:                                                                Person picked up by:
     Walker:                                                                        Person picked up by:

In case of an early dismissal, who will pick your child up?

Name:
Telephone No. (work and home)

Mom and Dad's Number:

Name and number of closest relative:

Parent's Signature:                                                                  Date:

Teacher's Note:

     If there are any changes, please notify me and the Center as soon as possible
.

                                                               Thanks,
                                                                     Miss. Hill- Room# 3