Onboarding: Emergency Contact Form

Emergency Contact Form

One Form Required Per Student
Student Information
Student's Name*

First NameLast Name
Student Grade*
Student Primary Ensemble*
Student ID Number*
Parent / guardian email*
example@example.com
Emergency Contact Info
This will be the emergency contact info for {studentsName}. Please make sure that our emergency contact information is up to date and someone can be reached should an emergency occur.
Emergency Contact*

First NameLast Name
Relation to Student*
Phone Number*
Phone Number (Alternate)
Secondary Emergency Contact*

First NameLast Name
Relation to Student*
Phone Number*
Phone Number (Alternate)
Health Insurance Info
Insurance Company Name*
Member ID No.*
Group ID No.*
Effective Date*

MonthDayYear
Date
Op-Out Policy

My student does not currently have insurance.
List any medical conditions, allergies, etc. (If there are no known medical conditions please indicate.)*
Will your child need to take or carry any prescription medications or medical devices (prescription inhaler, Epipen, Insulin, etc.)?*
Dietary Restrictions*

N/AVegetarianVeganGluten FreeDairy Lactose FreeNo Red Meat/PorkNut allergy (please give details in box below)Other
Additional Information
Should be Empty:

Emergency Contact Form