*
Required
St. John's Prep
Emergency Contact Form
Student First Name
*
required
Student Last Name
*
required
Parent First and Last Name
*
required
Parent Cell Phone
*
required
Additional Emergency Contact Name
*
required
Provide the name of person to contact in emergency if parent cannot be reached.
Cell Phone for Additional Emergency Contact
*
required
Allergies and/or Medical Conditions*
Does the student have allergies or medical conditions hos/he teacher should be aware of?
Yes
No
If you answered yes, please explain.
Epi-Pens
If student carries an epi-pen, can they self-administer?
Yes
No