EMERGENCY CONTACT FORM
2020-2021 "Blue Cards"

Welcome back to P.S. 184Q. As you know, Blue Emergency cards are distributed each year in September. This year we have once again offered our families the convenience and security of completing the emergency blue cards electronically. When you complete the online form below it will be printed and kept on file in the school and you do not need to take any further action. These cards are essential in ensuring quick and effective communication between the school and home, especially during an emergency. Please understand that these are legal documents and once they are completed, the school must abide by the information on the cards.

If at any time information on the card changes you MUST come into the main office to complete a new card.

Please help us gather contact and health information online by filling out the form below. You need to fill out this form per child attending PS184. All information gathered online is secure.
Please note: All fields with a red star * must be filled in. If field doesn't apply type in NONE or N/A.

STUDENT INFORMATION

PARENT / GUARDIAN INFORMATION

NOTE: If field doesn't apply type in NONE or N/A.
If a telephone number field does not apply just repeat the number you would like to use.

OTHER PARENT / GUARDIAN INFORMATION

NOTE: If field doesn't apply type in NONE or N/A.
If a telephone number field does not apply just repeat the number you would like to use.

EMERGENCY CONTACT INFORMATION

List below names of (3) people who may be called in case of an emergency or if child is sick.
CHILD WILL BE RELEASED ONLY TO PERSONS NAMED BELOW.
Please Note: The names listed below must be someone other than the Parent / Guardian listed above.
First Emergency Contact
Second Emergency Contact
Third Emergency Contact

HEALTH INFORMATION

NOTE: If field doesn't apply type in NONE or N/A.
Please Note: It is understood that in the final disposition of an emergency case, the judgement of the school authorities will prevail. The recommendation of the parent as indicated above will be respected as far as possible.

LIST ANY SIBLINGS

Sibling (1)
Sibling (2)
Sibling (3)
Sibling (4)
Principal will be notified in writing of any changes to the information on this form. Please Sign this form by typing your name below then hit submit to complete this form.