Emergency Information Card

Paste a picture of the child on the back - and update it every 6 months or so.  
Name of Childcare/Center: Caregiver Name:

 

Address of Home/Center:

 

Phone:
Child's Full Name:

 

Hair Color: Eye Color:
Birthdate: Home Phone#:
Address:
Mother's Name: Work Phone#:
Father's Name: Work Phone#:
Emergency Contact Name:

 

Home/Work Phone#::
Child's Doctor:

 

Office Phone #::
Medical Card#: Child's Personal ID#:

 

Allergies:

 

Medical Condition(s):

 

Medication(s):