Emergency Form

This is the form that we will refer to in the case of an emergency. A new Emergency Form must be submitted for every child annually.

Before submitting, please double check for these common errors:

1. Is a name and address listed for “Person Authorized to Pick Up Child (Daily)”?

2. Is there at least one emergency contact (with address and phone number) who is not the child’s parent/legal guardian?

3. Is the child’s physician information listed?

4. Is the form signed and dated?

5. Did you fill out the second page? If it doesn’t apply, write N/A in the relevant fields. Ensure both front and back of the form are complete before submission.