PS 154 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 (instead of 2 physical cards per child, if filled out on paper). If you have more than 3 children in PS 154, 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, but since it is printed it will be more legible).

If you choose, we will use the email address(es) to send you our Monthly Newsletter and other notices from the school via email. This will allow us to send information directly to you, via email. It will also cut down on the paper we send home. If you are already signed up, you will continue to get email notices until you unsubscribe (regardless of what you enter here).

All information other than email addresses (and child's grade, so we know which notices are appropriate for you) will not remain online after the initial sign in period.

Information marked ** can be shared with the PTA and classroom teacher *
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. Please confirm Yes if this is ok.
First Student Information
Please enter information about the first child attending PS 154
1st Student First Name** *
Your answer
1st Student Middle Initial
Your answer
1st Student Last Name** *
Your answer
1st Student Date Of Birth (MM/DD/YYYY) *
Your answer
1st Student Sex *
1st Student's Grade in 2018-2019 School Year** *
1st Student 2018-2019 Classroom** *
Name of Physician/Clinic: *
Your answer
Telephone of Physician/Clinic *
Your answer
1st Student Health Alert *
Does child have any health condition that may affect participation in physical activities?
1st Student Limitations (e.g., stair climbing, participation in gym)
Your answer
1st Student Allergies
Your answer
1st Student 504 services for the current year? *
1st Student 504 services for the previous year? *
1st 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 none of the 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 judgment of the school authorities will prevail. The recommendation of the parent as indicated below 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 154
DO NOT list students who also attend PS 154 (that information will be filled in below).
Your answer
Does this student have siblings who attend PS 154?
'No' will go to the Parent/Guardian Information section next, 'Yes' will allow entry of a second student's information
Please hit Next to continue ....
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