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Student Emergency Contact
Please keep this current. Tell the office straight away if a number changes.
Student's full name
*
(required)
Year group or class
*
(required)
Date of birth
*
(required)
Home address
*
(required)
Contacts, in the order we should try them
First contact - name and relationship
*
(required)
First contact - phone
*
(required)
Second contact - name and relationship
*
(required)
Second contact - phone
*
(required)
Third contact - name and relationship
Third contact - phone
Email for school messages
*
(required)
Medical
GP practice name and number
*
(required)
Medical conditions
Allergies and what to do
*
(required)
Medication held at school or taken during the day
Any arrangements in place?
Inhaler in school
EpiPen in school
Care plan
Physical access needs
Hearing or sight support
None of these
Consent
Staff may give basic first aid
*
(required)
If no contact can be reached, staff may consent to emergency medical treatment
*
(required)
This information is accurate and I will tell the school if it changes
*
(required)
Leave this field empty
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