Private Immersion School online emergency contact form (Spanish, French, German and Mandarin)

EMERGENCY CONTACT FORM
***This form must be on file before your child can attend class.
Child's Information
Last: *
First: *
Preferred Name:
Date of Birth: *
Gender: *
Home Address: *
City: *
State: *
Zip code: *
Home Phone: *
Email: *
Allergies/Special Information: *
Parent/Guardian Information
Last name: *
First Name: *
Work Phone:
Cell Phone:
Parent/Guardian Information
Last Name:
First Name:
Work Phone:
Cell Phone:
Child lives with: *
Emergency contacts
Name:
Phone:
Relation:
Name:
Phone:
Relation:
Name:
Phone:
Relation:
All children are required to be picked up from the classroom inside the school. No children will be walked to their cars. Be aware that we will ask all persons picking up a child for identification. Please advise your emergency contacts of this policy so they are prepared.