Emergency Contact Form Student Name:(Required) Full Name Grade / Class(Required) TK (4 years old) KG (5 years old) 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th grade Parent/Guardian :Full Name of Parent/Guardian:(Required) Full Name Email:(Required) Primary Phone Number:(Required)Secondary Phone Number:Emergency Contact #1:Full Name of Emergency Contact:(Required) Full Name Relationship to Student:(Required)Primary Phone Number:(Required)Secondary Phone Number:Emergency Contact #2:Full Name of Emergency Contact: Full Name Relationship to Student:Primary Phone Number:Secondary Phone Number:Family Doctor:Full Name of Family Doctor: Full Name Phone Number:Medical Conditions / Allergies (if any)Additional Notes:Consent(Required) I certify that the above information is true and accurate. I authorize the school to contact the listed persons in case of emergency, and I understand it is my responsibility to update the school if any information changes.
