2019 Emergency Contact Form

This form MUST be on file in the Theatre office BEFORE the student rehearses or works tech NO EXCEPTIONS.
This information will be shared with the appropriate school staff. If the designated parties on this sheet are not available, I understand appropriate emergency care deemed advisable by school authorities will be sought. Any special directions appropriate to my child have been checked and noted on this sheet. *
Student's Legal First Name *
Example: Jane
Student's Legal Last Name *
Example: Smith
Student's School ID Number *
Please enter the student's school identification number
Please enter current residence *
Street, City and Zip Code
Please enter the student's date of birth *
Month, Day, Year ( Example: 09/01/1998)
Currently, what schools does the student attend? *
Please fill in the appropriate information
Which productions does the student intend to participate in? *
Please check all that apply
Required
Parent/Guardian's Name *
Home Phone Number *
Example: 734-123-4567
Parent Cell Number *
Example: 734-123-4567 or N/A
Parent Cell Number *
734-123-4567 or N/A
Parent Work Phone Number *
Example: 734-123-4567 or N/A
Emergency Contact Name *
Emergency Contact's Phone Number *
Example: 734-123-4567
Family Physician *
Physician's Phone Number *
Example: 734-123-4567
Preferred Hospital *
Family Dentist *
Dentist's Phone Number *
Example: 734-123-4567
Date *
Please enter today's date. (Example: 01/06/2013)
Submit
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