Emergency Contact Form 2020-2021

Please fill out this form to share your child's emergency contact information. If you have more than one child, we assume that the individuals to contact in the case of an emergency will be the same for ALL of your children. The allergy/medical portion of this form should be completed for EACH CHILD you have enrolled at Northstar School.
Primary Parent/ Guardian Info
Please designate one parent as the primary contact.
PRIMARY Parent/ Guardian Name*
This parent should be contacted first in an emergency.
First Last
Primary Parent Cell Phone*
Primary Parent/ Guardian Home or Work Phone*
Primary Parent Email*
Home Address of Primary Parent/ Guardian*
Street Address City State ZIP Code
Secondary Parent/ Guardian
SECONDARY Parent/ Guardian Name*
This parent should be contacted second in an emergency.
First Last
Secondary Parent Cell Phone*
Secondary Parent/ Guardian Home or Work Phone
Secondary Parent/ Guardian Email
Is the address of the primary parent/guardian the same as the secondary parent/guardian?*
- Yes
- No
Secondary Parent/ Guardian Address
Street Address City State ZIP Code

Emergency Contact #1
Please list two emergency contacts other than the parents/guardians.
Emergency Contact #1 Name*
First Last
Emergency Contact #1 Cell Phone*
Emergency Contact #1 Email*
Emergency Contact #1 Address*
Street Address City State ZIP Code
Emergency Contact #2
Emergency Contact #2 Name*
First Last
Emergency Contact #2 Cell Phone*
Emergency Contact #2 Email*
Emergency Contact #2 Address*
Street Address City State ZIP Code

(2) Emergency Contact Form