Emergency Contact/Pick-Up Form
In the case of an emergency or natural disaster please nominate pick-up people for your child in case you are unable to get to school or the evacuation assembly area at  Rokko Island elementary school
Sign in to Google to save your progress. Learn more
Name of student (Surname/first name) *
Date of birth *
Name of student (Surname/first name)
Date of birth
Name of student (Surname/first name)
Date of birth
Name and contact phone numbers of parent/gardian (1) *
Name and contact phone numbers of parent/gardian (2)
The following person can pick-up my child in the event of an emergency or natural disaster and I am unable to get to Rokko Island.
Name/contact number/relationship to child (1)
 *
The following person can pick-up my child in the event of an emergency or natural disaster and I am unable to get to Rokko Island. 
Name/contact number/relationship to child (2)
The following person can pick-up my child in the event of an emergency or natural disaster and am I unable to get to Rokko Island. 
Name/contact number/relationship to child (3)
By submitting this form I give DSKI permission to release my child to the people listed in an emergency if I am unable to get to the school or the evacuation assembly area at  Rokko Island elementary school  . *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Deutsche Schule Kobe International.

Does this form look suspicious? Report

Google Forms