PS 33 Chelsea Prep Emergency Contact Form
Please fill out this Emergency Contact Form. Student will be released ONLY to adults listed.
Email address *
Student Last Name *
Your answer
Student First Name *
Your answer
Student Middle Name
Your answer
Address *
Your answer
Apt # *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone #
Your answer
Mother/Guardian Last Name
Your answer
Mother/Guardian First Name
Your answer
Mother/Guardian Cell Phone #
Your answer
Mother/Guardian email
Your answer
Mother/Guardian Work Phone #
Your answer
Father/Guardian Last Name
Your answer
Father/Guardian First Name
Your answer
Father/Guardian Cell Phone #
Your answer
Father/Guardian email
Your answer
Father/Guardian Work Phone #
Your answer
Preferred Language Spoken *
Required
Preferred Language Written *
Required
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