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EMERGENCY CARD
* Indicates required question
Student's Name
*
Your answer
Student's Grade
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Required
Student Address
*
Your answer
Parent/Guardian Names
*
Your answer
Home Phone Number
*
Your answer
Father's Work Number
Your answer
Father's Cell Number
*
Your answer
Father - Alternate Number
Your answer
Mother's Work Number
Your answer
Mother's Cell Number
*
Your answer
Mother - Alternate Number
Your answer
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