Randazzo Dance Company Emergency Contact Form 2018
This form MUST be completed by the first day of rehearsal.
Dancer's Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Dancer's Home Address *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Cell Phone *
Your answer
Parent/Guardian Home Phone (if applicable)
Your answer
Parent/Guardian Work Phone (if applicable)
Your answer
Please list the name, relationship, and phone number of people you would like notified in case of an emergency *
Your answer
Any Known Allergies or Medical Conditions? (if yes, please explain) *
Your answer
Any Medications that we need to be aware of? (if yes, please explain) *
Your answer
In the case of an emergency, I give permission for my information to be released to emergency personnel. I also agree that any of the contacts listed may be notified in an emergency, as needed. *
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