RHS Emergency Blue Cards & Consent to Photograph 2020-21
Please complete this form to provide detailed contact information for your child. This information will be used to contact you about day to day information at Renaissance as well as in the case of emergency.
Student First Name: *
Student Last Name: *
Student Date of Birth: *
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Student OSIS/Student ID Number: *
Student Cell Phone Number: If none please put N/A. We use this to inform students via text about upcoming events, assignments or tests. *
Who does the student live with? (Ex. Mom, Mom & Dad, or Grandma) *
Address Where Student Resides: This address is where mailings will be sent. Please include street address, apartment #, city and zip code. *
Parent/Guardian #1 First & Last Name: *
Parent/Guardian #1 Cell Phone Number *
Parent/Guardian #1 Email Address: If none, please put N/A *
Parent/Guardian #2 First & Last Name: (If none, put N/A) *
Parent/Guardian #2 Cell Phone Number *
Parent/Guardian #2 Email Address: If none, please put N/A *
Emergency Contact #1: In case of emergency and we are unable to get in touch with the parent/guardians listed above, who should we contact? Please list name, relationship to student & phone number where they can be reached. (Put N/A if only parents/guardians listed above should be contacted.) *
Emergency Contact #2: In case of emergency and we are unable to get in touch with the parent/guardians listed above, who should we contact? Please list name, relationship to student & phone number where they can be reached. (Put N/A if only parents/guardians or contact #1 listed above should be contacted.) *
Emergency Contact #3: In case of emergency and we are unable to get in touch with the parent/guardians listed above, who should we contact? Please list name, relationship to student & phone number where they can be reached. (Put N/A if only parents/guardians, contact #1 or #2 listed above should be contacted.) *
Please list any medical conditions your child has. (Ex. asthma & has pump she carries, allergic to peanuts- no epi pen). Be specific. *
Is there anyone who should not have any access to your child? *
Name of Person who should not have access to your child.
Any additional information we should know about your child. If no additional information please put N/A. *
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