Student Emergency Form
Reminder: All medications for use at school need a doctor’s order and parent permission slip.
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Parent/Guardian Cell Number: *
Student FULL First Name: *
Student FULL Last Name: *
The LASID is your child's student ID number and their lunch number.  If you do not know you child's LASID, please ask your child and if they do not know, you can call the school and we will tell you.  Any document received without a proper LASID will slow down the process of entering your information.
Student LASID Number: *
Student Date of Birth: *
MM
/
DD
/
YYYY
Student Grade: *
Student Home Address: *
Is this the address where you receive mail? *
Parent or LEGAL Guardian Name: *
Second Parent or LEGAL Guardian Name (if applicable): *
Home Phone Number: *
Parent/Guardian Work Number:
Parent/Guardian Email: *
PRIMARY Language Spoken At Home: *
How will you child be transported to and from school? (Check all that apply): *
Required
When IN school, where does your child go after school at 2:10 PM? *
Required
If your child is remote and not working from home, please give us the name and phone number where s/he will be working remotely.
Remote Contact Name:
Remote Contact Phone Number:
Emergency Contacts: If the parent/guardian cannot be reached, who should we contact in case of emergency? Anyone listed as an Emergency Contact will be allowed to dismiss your child from school.
Emergency Contact #1 *
Contact #1 Relationship to Student: *
Contact #1 Phone Number: *
Emergency Contact #2:
Contact #2 Relationship to Student:
Contact #2 Phone Number:
Please list the FULL NAME(s) of any siblings that are also in Lowell Public Schools.
Do you give permission for the school to use your child's name, photo and video during special events and activities? (Check all that apply)
Permission *
Required
Click Yes or No if you read the Lowell Public Schools Student Handbook.  You can find it here:
https://www.lowell.k12.ma.us/site/Default.aspx?PageID=147 
I have read & discussed the Lowell Public Schools Handbook from the internet with my child. *
Click Yes or No if you read the Lowell Public Schools Acceptable Use Policy for the internet.  You can find it here:  
https://www.lowell.k12.ma.us/cms/lib/MA01907636/Centricity/Domain/94/Acceptable%20Computer%20Usage%20Hardware%20Software%20Policy.pdf 
I have read & discussed the Lowell Public Schools Acceptable Use Policy for the internet with my child: *
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