Student Emergency Information Form

Emergency Information Form

Wolf Creek Google Docs Emergency Enrollment Form ( Student Emergency Form )

* Indicates Required Fields

** School staff can only contact the adults listed below. Please make sure your list is complete.

Check this box if there is a court order preventing any person from contacting your student at school. Please see the Director if the medication will be taken at school.. Legal documents must be on file at school if a biological parent is involved. Please list the names of those individuals:

List at least two emergency contacts willing to assume care of your child if you cannot be reached:

Medications: List any medications the student takes. Please see the Dean of Students if the medication will be taken at school.

Health Information: List any health conditions that could result in an emergency (severe allergies, diabetes, seizure, asthma)

Hearing or vision concerns that staff should be aware of:

Immunizations within the last year: (Type and mo/day/year)

The above information is considered confidential. This information is not required for your child to attend school, however, it is required for campus attendance. You may choose to omit any question on this form. The information you provide will be shared only with staff in the school whose jobs require access to this information to ensure your child’s safety and school success and with Emergency Personnel in the event 911 is called. Please ask the Director for a confidential conference if your student has a special health concern.