Home Administration/Faculty Calendars Classroom Happenings Holy Family Church Newsletters Parent Information Student Information |
Holy Family School - Emergency
Form
Date: _____________ Family Name: _______________ Parents' Names: ___________________________________ _________________________________________________ Names of children attending HFS: _______________________________________ grade: ______ _______________________________________ grade: ______ _______________________________________ grade: ______ _______________________________________ grade: ______ Student(s) live with: _____ Both Parents _____ Father _____ Mother _____ Guardian Home Phone: __________________________________ Parents' Cell Phones: _________________________ (mother) ________________________________ (father) Parent email address __________________________ (mother) ________________________________ (father) Specify any known allergies or special conditions of your children: __________________________________________________________ __________________________________________________________ __________________________________________________________ In the event of illness, emergency, or accident to the child/ren named above, the school is authorized to contact the people named below: (Please number to indicate who should be called first, second, third) ______ Father: ______________________________ (employment) ______________________________ (phone) ______ Mother:______________________________ (employment) ______________________________ (phone) ______ Relative/Guardian: ______________________________ (employment) ______________________________ (phone) Names of persons authorized to pick up child(ren) in addition to parents: (Please contact the school if someone different than parent or person(s) listed below will be picking up your child at dismissal.) (Contact the school in person if you need to add or remove someone from your pick-up list.) ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ In the event of (1) an accident and (2) the inability of Holy Family School to contact us, the parents, we request Holy Family School to move our child(ren) to _____________________________ Hospital for treatment in case of an emergency. Name of Physician: ____________________________________________________ Phone: ______________________________________ Parent Signature(s): _____________________________________ _____________________________________________________ Please update form as data changes. Emergency Dismissals: In case of an emergency dismissal, children must have an alternate place to go should a parent not be available to pick up their child(ren) from school. Parents are asked to discuss with their child(ren) an alternative plan and make appropriate arrangements for use of the plan. Please list any pertinent data / details regarding emergency dismissal arrangements for your children: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ State of Illinois Textbook Loan Program In order to qualify for free textbooks from the State of Illinois, we must have on file forms signed by all parents indicating their approval of our request for free textbooks. Please read and sign the "Request for the Loan of Textbooks" statement below: I hereby request the loan of secular textbooks in accordance with Public Act 79-961 of 1975 of the State of Illinois. For the academic year of 2007-2008 I have children in grades ______, ______, ______, and ______ of Holy Family School, Danville, Illinois, Vermilion County Signed: ___________________________________(parent or guardian) Date: ____________________________________ |