Emergency Contact Sheet

ADVERTISEMENT

Emergency Contact Sheet
Please print clearly and list emergency contact information that can be reached during HSLI program hours.
Student Name (print name) ___________________________________________________________________________
Student Date of Birth ________________________________________________________________________________
Section I – Personal Information
Student E-mail: _________________ ____________________________________________________________________
Address (Number and Street): _________________________________________________________________________
Apartment No.: ____________City: _______________________State: ____________Zip Code: ____________________
Parent/Legal Guardian Name: _____ ____________________________________________________________________
Relationship to Student: ______________________________________________________________________________
Home Phone: (_________)____________________________________________________________________________
Alternate Phone: (_________)__________________________________________________________________________
Section II – Emergency Contact Information
Emergency Contact 1 – Name: _____ ____________________________________________________________________
Relationship to Student: ________________________________Phone: (________)______________________________
Emergency Contact 2 – Name: _____ ____________________________________________________________________
Relationship to Student: ________________________________Phone: (________)______________________________
40 Washington Square South ● New York, NY 10012 ● ●

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 4