Emergency Information Card

Father:
____________________________________________________
Employer:
_________________________________________________
Work Phone: ___________________
_______________________

Cell:

Other Phone:
_______________________________________________
E-mail:
____________________________________________________
Driver License #: _________________
______________

Date of Birth:

---------------------------------------------------------------------------------------------Mother:
___________________________________________________
Employer:
_________________________________________________
Work Phone: ___________________
_______________________

Cell:

Other Phone:
_______________________________________________
E-mail:
____________________________________________________

Driver License #: _________________

______________

Date of Birth:

----------------------------------------------------------------------------------Please list any person, with a phone number, allowed to pick up your child.