Student emergency contact form template

About this student emergency contact form

Schools must be able to reach a parent or trusted adult quickly if a child is ill, hurt or needs collecting early. The student emergency contact form lists parents and two other contacts in order, everyone authorised to pick the child up, the family doctor, medical conditions and consent for emergency treatment.

Ask families to update it whenever a phone number changes, and keep a copy in the office and one with the class teacher.

What’s on the student emergency contact form

The template has 6 sections and 14 questions. Every one can be renamed, moved or deleted.

• Student: Student name; Class / grade; Date of birth; Blood group
• Parents or guardians: Parents table (Name, Relationship, Mobile, Work phone)
• Emergency contacts (in order): Contacts table (Name, Relationship, Mobile, Other phone)
• Authorised to pick up: Names of people allowed to collect my child; People who may NOT collect my child
• Medical: Family doctor and phone; Medical conditions; Allergies; Medication; Agreement: “In an emergency, staff may arrange medical treatment if I cannot be reached.”
• Signature: Parent or guardian signature with date

Tips

• Ask for at least two contacts who aren’t the parents.
• Check the pickup list before releasing a child to someone new.
• Send the form home again mid-year to catch changes.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.