Emergency Contact Information
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Student's Last Name
Your answer
Student's First Name
Your answer
Grade Level for the 2017-2018 School Year
Student's Date of Birth
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DD
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YYYY
Primary Emergency Contact #1 (Parent/Guardian's Full Name)
Your answer
Primary Emergency Contact #1 Cell Phone
Your answer
Primary Emergency Contact #1 Work Phone
Your answer
Primary Emergency Contact #2 (Parent/Guardian's Full Name)
Your answer
Primary Emergency Contact #2 Cell Phone
Your answer
Primary Emergency Contact #2 Work Phone
Your answer
In the event of an emergency, a parent/guardian will be contacted.  In the event the parent(s) cannot be contacted, the following person should be contacted:
Alternate Emergency Contact's Name (other than parent/guardian):
Your answer
Relationship to Student
Your answer
Alternate Emergency Contact's Cell Phone
Your answer
Alternate Emergency Contact's Work Phone
Your answer
Allergies
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Other Necessary Information
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Despite everyone’s best efforts this year, some of our students may incur an injury while participating in athletics and other activities. Concordia Lutheran High School does not provide accident insurance to cover the cost for medical treatment of these injuries. However, we have arranged for our families to have the option of purchasing a Student Accident Insurance plan if they wish to do so. Coverage is through Markel Insurance and the premium cost is very reasonable. Information regarding coverage can be found in your registration packet provided at Final Registration.
Please acknowledge that you have read the above statement and understand that Concordia Lutheran High School does not provide accident insurance to cover the cost for medical treatment of injuries that may incur while participating in athletics and other school activities.
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