Emergency Contact Card
Student Information
Last Name
First Name
Middle Initial
ID Number
Date of Birth
MM
/
DD
/
YYYY
Sex
Clear selection
Parent/ Guardian Information
Parent/Guardian Name
Relationship
Preferred Language of Communication
Written
Oral
Phone Number
Home Phone
Work Phone
Cell Phone
Home Address
Email Address *
Other Parent Guardian Contact Information
Other parent/ guardian name
- Relationship
- Preferred language of communication
- Written
- Oral
- Home Phone
- Work Phone
- Cell Phone
- Home Address
- Email Address
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