Emergency Release Form

Emergency Contacts (Other than Above)

In the event of an emergency situation at the school whereby all students are dismissed early, in addition to the individuals listed above, I authorize the school to release my child to:

Health History

(Type 'None' if not applicable)

The signing of this document means:

  1. I have received, read and understand all that has been stated in this document and Student Handbook.
  2. The signature below will serve as authorization of treatment by school personnel and for the school personnel to release necessary information in an emergency.
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