Saint John the Baptist Catholic School Family Information Sheet

Last Name Home Phone #

Address

(City) (Zip)

E-Mail Address

Child’s Name Birth Date Grade/Teacher

Mother’s Name Employer

Work Phone # Occupation

Cell #

Father’s Name Employer

Work Phone # Occupation

Cell #

Emergency Information

In case of an emergency, Saint John staff will attempt to contact the parent(s) first. In case the parent(s) cannot be reached, please indicate two other persons who may be notified.

Name Phone #

Relationship Address

Name Phone #

Relationship Address

Family Dr. Phone # Pref. Hospital

Medical concerns we should be aware of

Parent Signature Date

Please fill out back

Authorization to pick up my child from

Saint John the Baptist Catholic School

I hereby give my consent for the following individual(s) to pick up my child from Saint John the Baptist Catholic School.

Name Phone # Relationship

Name Phone # Relationship

Parent Signature Date

Emergency Transportation Authorization

If your child is in need of emergency care, 911 will be called for emergency service. Your signature allows us to call for emergency transportation for your child.

I give Saint John the Baptist Catholic School permission to transport my child(ren) by emergency vehicle for emergency medical care.

Parent Signature Date

Refusal to Grant Authorization for Emergency Transportation

I do not give Saint John the Baptist Catholic School permission to transport my child(ren) by emergency vehicle for emergency medical care.

Parent Signature Date