Template · Comms

Student Emergency Contact Form

Compliance form for emergency contacts and medical info.

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EMERGENCY CONTACT & MEDICAL INFO

Student: __________ | Class: __ | Adm No: __________

Primary Contact:
- Name: __________ Relationship: ______ Mobile: __________
Secondary Contact:
- Name: __________ Relationship: ______ Mobile: __________

Home Doctor: __________ Clinic: __________ Phone: __________
Hospital Preference: __________

Blood Group: __ | Allergies: __________
Chronic Conditions: __________
Regular Medications: __________

Insurance: __________ Policy #: __________

Authorization: In case of emergency, I authorise the school to seek necessary medical attention.

Parent Signature: __________ Date: __/__/____