Emergency Contact Form

Dear DGK Family,

In order to be sure that you receive our automated school notification calls concerning school closings and other important messages, we are currently updating our student/family and emergency contact records again. Please review the following information below and make any necessary corrections/changes/additions. Kindly return this form to your child’s teacher. Thank you for your prompt attention to this matter.

Student's Name

First Name

Last Name

Current Grade

Birth Date

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Name

First Name

Last Name

Father's Name

First Name

Last Name

Email Address

Alternate Email Address

Home Phone

(###)

###

####

Mother's Cell Phone

(###)

###

####

Father's Cell Phone

(###)

###

####

Emergency Contact

First Name

Last Name

Relationship

Emergency Contact Phone

(###)

###

####

Doctor's Name

First Name

Last Name

Doctor's Phone

(###)

###

####

Allergies

Has our school nurse been notified?

Yes

No

Is student able to participate in physical activities?

Yes

No

Additional Information

If we are unable to reach you in the event of an emergency we will contact your provided information.

It is understood that in the final disposition of an emergency, the judgment of the school authorities will prevail and the recommendation of the parent as indicated above will be respected as far as possible.