2017-2018 DIOCESE OF ARLINGTON PERMISSION FOR EMERGENCY CARE

This form is to be completed by the parent/guardian at beginning of school year.  You will need to complete a form for each child.  All fields must be filled in.  If a field is not applicable to your student, please enter "N/A".
 
Please provide two (2) emergency contacts with phone numbers other than yourself and your spouse.


Emergency Contacts:  In the event a parent cannot be reached, you must give the name, address and phone number of two persons who could pick up and take your child home in a timely manner.
I agree to *
I understand and agree *
I agree and understand *