|
Eaton Early Learning Center
Emergency Information Card
|
|
|
|
| Child’s
Name_________________________ |
Birthdate___________________________ |
| Blood
Type _________ |
Allergies____________________________ |
|
Medications_____________________________________________________________ |
|
Address____________________________ |
Home Phone__________________________ |
|
|
|
| Mother’s
Name_______________________ |
|
|
Address____________________________ |
Home
Phone__________________________ |
|
Employer___________________________ |
|
| Work
Hours_________________________ |
Work Phone _________________________ |
|
|
|
|
Father’s Name________________________ |
|
|
Address____________________________ |
Home Phone__________________________ |
|
Employer___________________________ |
|
| Work
Hours_________________________ |
Work Phone _________________________ |
|
|
|
|
Person other than parent to be notified in an emergency situation when parents
are not available
|
|
Name______________________________ |
|
|
Address____________________________ |
Home Phone__________________________ |
|
Employer___________________________ |
|
|
Work
Hours_________________________ |
Work Phone _________________________ |
|
|
|