Williamsburg Parent Emergency Contact Information Sheet
Email address *
Additional email address for other parent or guardian. (Only enter this if you want to receive updates, announcements, etc. about the trip).
Your answer
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Gender *
Child's Cell Phone number (if applicable) *
Your answer
Parent or Legal Guardian's First and Last Name *
Your answer
Parent or Legal Guardian's Phone Number (please include best number to reach in case of emergency). *
Your answer
Parent or Legal Guardian's First & Last Name
Your answer
Parent or Legal Guardian's Phone Number (please include the best number to reach in case of emergency).
Your answer
Emergency Contact (not parent or guardian) First and Last Name *
Your answer
Emergency Contact (not parent or guardian) Cell Phone Number *
Your answer
Please list any health conditions or allergies for your child that the chaperones need to be aware of (just write none if there are no allergies or health issues). *
Your answer
If my child needs minor first aid, or over the counter medications (ex. for headache, stomach ache, etc), I give permission for a chaperone to administer this medication. *
I am providing a copy of my student’s insurance card in the event of an emergency medical situation. Even with this, the chaperone will attempt first to contact the student’s parent/guardian. *
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