Student Emergency Information
Parent/Guardians:  Occasionally children become ill while they are in school or they may have an accident (usually not serious).  The school must have on file information that can be used to contact you.  Please give the following information for emergency use only.  Please submit this form to update any contact information.
Sign in to Google to save your progress. Learn more
Student ID
(Your Child's CPS Student ID)
Student Last Name
Student First Name
Student Middle Initial
Room
Student Address
Zip Code
Home Telephone Number
Cell Phone Number
Email Address
Confidential Current Living Situation
Complete this box only if it reflects your child's current living situation; or if you are a youth not living with your parents or guardian.
Emergency Contact 1 (Parent/Guardian Info)
Name
Emergency Contact 1 (Parent/Guardian Info)
Relationship
Emergency Contact 1
Cellular Phone Number
Emergency Contact 1
Cellular Phone Number
Emergency Contact 1 (Please complete, if different from student's information)
Address
Emergency Contact 1
Name of Employer
Emergency Contact 1
Work Phone Number
Emergency Contact 1
Address of Employer
Emergency Contact 2 (Parent/Guardian Info)
Name
Emergency Contact 2
Relationship
Emergency Contact 2
Home Telephone Number
Emergency Contact 2
Cellular Phone Number
Emergency Contact 2 (Please complete, if different from student's information)
Address
Emergency Contact 2
Name of Employer
Emergency Contact 2
Work Phone Number
Emergency Contact 2
Address of Employer
Confidential Information Box 2
Is there an a current Order of Protection or No Contact order which concerns this student? If "Yes", order of protection documents must be turned into the main office by the first day of school.
Contact 1 Name of Relative or Neighbor who can be notified in case of illness or accident
Name
Contact 1
Relationship
Contact 1
Address
Contact 1
Telephone #
Contact 2 Name of Relative or Neighbor who can be notified in case of illness or accident
Name
Contact 2
Relationship
Contact 2
Address
Contact 2
Telephone #
Family Doctor (If we cannot reach you & feel your family doctor is needed, please supply this information)
Name
Family Doctor
Doctor Address
Family Doctor
Doctor Telephone
By checking this box you authorize us to contact the doctor if necessary.
Please list any sibling(s) who attend Thorp currently
Sibling 1
Sibling 1 (Student ID)
 
Sibling 2
 
Sibling 2 (Student ID)
Sibling 3
Sibling 3 (Student ID)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy