OHS BLUE CARD (EMERGENCY CONTACT CARD SCHOOL YEAR 2020-2021
September 2020
Email *
Student: Last Name *
Student: First Name *
Child's Grade *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Email Address *
Street Address with Apt (e.g. 123 4th St, Apt. 5) *
Street Address with Apt (e.g. 123 4th St, Apt. 5) If multiple addresses exist *
City, State *
Zip Code *
Street Address with Apt (e.g. 123 4th St, Apt. 5) If multiple addresses exist *
City, State *
Zip Code *
Parent/Guardian Home Number *
Parent/Guardian Cellphone Number *
Additional Phone Number (please state relationship to child, e.g. Aunt, (347) 123-3456 )
List below names of three (3) persons who may be called in case of emergency or if child is sick in school. (State relationship to child. e.g. Laura Lee, Aunt, (347)-111-2345 ) *
If there is a person who may NOT HAVE ACCESS to child, please indicate:
If yes, What's the name of the person and his/her relationship to child?
Does an Order of Protection Exist?
Clear selection
Does child have any health condition that may affect participation in physical activities? *
Does you child has any health-related limitations, e.g. stair climbing, participation in gym, etc *
Does your child has any known Allergies? *
Does your child have an IEP, 504 services, etc.? *
Do you have any information/suggestions you wold like to share with the school?
A copy of your responses will be emailed to the address you provided.
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