Free Student Emergency Contact Form Template
Student Emergency Contact Form
Please complete this form to provide emergency contact information.
Name
Home Address
Contact Number
Email Address
Primary Emergency Contact
Name
Relationship to Student
Contact Number
Secondary Emergency Contact
Name
Relationship to Student
Contact Number
Authorization & Consent
I authorize school staff to contact the emergency contacts listed above in case of an emergency. I understand that this information will be kept confidential and used only for emergency purposes.
Name:
Date:
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