EMERGENCY CONTACT INFORMATION:  Please print clearly.

Name:  ______________________________________________________________________

Grade:  _______  Email Address:  _______________________________________________

Phone Number:  (____)____________  Cell Phone Number:  (____)__________________ 

Home Address:  ______________________________________________________________


Parent or Guardian's Name:  ____________________________ Email: ______________________ 

Phone:  (____)__________ Work Number:  (____)__________  Cell Number:  (____)_________

Parent or Guardian's Name:  ___________________________ Email: _______________________ 

Phone:  (____)____________ Work Number:  (____)_________  Cell Number:  (____)___________

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Emergency Contact Information:

Name:  ______________________________________________________________________

Phone:  (____)_________   Cell Number: (____)__________ Work Number:  (____)____________ 
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Do you have any medical conditions and/or allergies?__________________________

______________________________________________________________________________ 

Can you receive Advil/Tylenol/etc?____________________________________________

Anything else we should know? ________________________________________________ 

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School Schedule:         Class                                 Teacher
1st ___________________________________________________________________________ 

2nd ___________________________________________________________________________

3rd ___________________________________________________________________________

4th ___________________________________________________________________________ 

5th ___________________________________________________________________________

6th ___________________________________________________________________________

7th ___________________________________________________________________________ 

8th ___________________________________________________________________________


Parent Signature_____________________________________________________