Free Child Care Emergency Contact Form Template
Child Care Emergency Contact Form
Please complete this form to provide essential contact and medical information for your child in case of emergencies.
Child's Information
Name
Date of Birth
Address
Parent/Guardian Information
Name
Phone (Home)
Phone (Work)
Phone (Mobile)
Emergency Contacts (Other than Parents/Guardians)
Name
Relationship to Child
Phone number
Medical Information
Allergies:
Medical Conditions:
Medications:
Physician Name
Physician Phone
Preferred Hospital
Authorization for Medical Treatment
-
I authorize the child care provider to seek medical attention for my child if I cannot be reached.
Name:
Date:
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