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ELC Emergency Card

ELC Emergency Card

Medical Emergency Contacts
Please note that all fields are required.  Please list both parents (if applicable) and two additional medical emergency contacts. If a field is not applicable, please type N/A.

Emergency Contact #1


Emergency Contact #2


Emergency Contact #3


Emergency Contact #4


I give my permission for my child to be released from the program to the people listed above. These names will be listed on our "Release To" sheet. Please note: Changes to this list must be done in writing.
Sun, October 24 2021 18 Cheshvan 5782