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
Your answer
Student's Legal Last Name *
Example: Smith
Your answer
Student's School ID Number *
Please enter the student's school identification number
Your answer
Please enter current residence *
Street, City and Zip Code
Your answer
Please enter the student's date of birth *
Month, Day, Year ( Example: 09/01/1998)
Your answer
Currently, what schools does the student attend? *
Please fill in the appropriate information
Your answer
Which productions does the student intend to participate in? *
Please check all that apply
Required
Parent/Guardian's Name *
Your answer
Home Phone Number *
Example: 734-123-4567
Your answer
Parent Cell Number *
Example: 734-123-4567 or N/A
Your answer
Parent Cell Number *
734-123-4567 or N/A
Your answer
Parent Work Phone Number *
Example: 734-123-4567 or N/A
Your answer
Emergency Contact Name *
Your answer
Emergency Contact's Phone Number *
Example: 734-123-4567
Your answer
Family Physician *
Your answer
Physician's Phone Number *
Example: 734-123-4567
Your answer
Preferred Hospital *
Your answer
Family Dentist *
Your answer
Dentist's Phone Number *
Example: 734-123-4567
Your answer
Date *
Please enter today's date. (Example: 01/06/2013)
Your answer
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