PS 372 Emergency Contact and Health Information (Blue Card)
Please help us gather contact and health information online. You need only fill it out once for up to 3 children. If you have more than 3 children in PS 372, fill this out for the oldest 3 and then do again for the other children.

We will print 'Blue Cards' for use in the main and nurse's office (just as they have been used historically, but since it is printed it will be more legible), and a classroom set will be provided to the student's teaching team.

If you choose, Student Name, DoB, Grade/Class, and Parent contact information may be shared with the PTA for emails and events and to update the PTA directory. No emergency nor medical information will ever be shared with the PTA.

All information will not remain online after the initial sign-in period. Updates to this information will need to be made via the Main Office.

The email address below will be used to send a confirmation of the information submitted on this form, if requested.
Email address *
Information marked ** may be shared with the PTA and classroom teachers *
Information will be used to generate the student/parent contact list for each class and update the PTA directory to use when sending email PTA emails & notices. Only contact information will be shared, no emergency nor medical information will be included. Please confirm Yes if this is ok.
First Student's Information
Student's Last Name** *
Your answer
Student's First Name** *
Your answer
Student's Middle Initial
Your answer
Date of Birth (please use birth year, not 2019)** *
MM
/
DD
/
YYYY
Grade** *
Class (i.e. pick 1 if student is in 2-1 or 4-1, etc.)** *
Student's Nickname**
Your answer
Student's Gender *
Student's Physician/Clinic *
Your answer
Physician/Clinic Phone Number *
Your answer
Student Health Alert? *
Student Limitations? (e.g., stair climbing, participation in gym)
Your answer
Student Allergies?
Your answer
Student 504 services for the current year? *
Student 504 services for the previous year? *
Student has (check any that apply) *
Required
If “No Health Insurance,” are you willing to share contact information from this card to learn about insurance options?
If no named contacts can be reached, what do you wish the school to do if your child is sick or injured?
It is understood that in the final disposition of an emergency case, the judgement of the school authorities will prevail. The recommendation of the parent as indicated above will be respected as far as possible.
Your answer
Does this student have siblings IN A DIFFERENT school? Please give name (First & Last) and School for all siblings NOT at PS 372
DO NOT list students who also attend PS 372 (that information will be filled in below).
Your answer
Does this student have siblings who attend PS 372?
'No' will go to the Parent/Guardian Information section next, 'Yes' will allow entry of a second student's information
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