>Home >Enrollment >Emergency Contact/Authorized Pick-Up Persons Share Email Print Facebook Twitter Emergency Contact/Authorized Pick-Up Person . The school has permission to contact the following adults for medical emergencies such as ER treatment, field trip permission or to pick up my child(ren) during or after school when I cannot be contacted. Emergency Contact #1 - Full Name Emergency Contact #1 - Phone Number Emergency Contact #1 - Relationship Emergency Contact #2 - Full Name Emergency Contact #2 - Phone Number Emergency Contact #2 - Relationship Emergency Contact #3 - Full Name Emergency Contact #3 - Phone Number Emergency Contact #3 - Relationship Emergency Contact #4 - Full Name Emergency Contact #4 - Phone Number Emergency Contact #4 - Relationship Emergency Contact #5 - Full Name Emergency Contact #5 - Phone Number Emergency Contact #5 - Relationship Signature NOTE: Students will not be allowed to leave with anyone not listed above. If for some reason you need someone other than those listed above to pick up your child you must notify the office ahead of time in writing or your child will not be allowed to leave with that person. Signature of parent/guardian providing names of contact persons: Date Submit
