Date Updated: 11/6/2017 Emergency Contact Information

This form is to be completed by the parent and submitted to the Blessed Sacrament School office. It is your responsibility to notify the office of any changes. The office phone number is (859) 331-3062.

Parent Last Name	Mother	Father
Click here to enter text.	Click here to enter text.	Click here to enter text.
Click here to enter text.	Click here to enter text.	Click here to enter text.
Children’s Names:	Click here to enter text.
Mother	Father
Home Address:	Click here to enter text.	Click here to enter text.
Home Phone:	Click here to enter text.	Click here to enter text.
Place of Employment:	Click here to enter text.	Click here to enter text.
Work Phone:	Click here to enter text.	Click here to enter text.
Cell Phone:	Click here to enter text.	Click here to enter text.
E-Mail Address:	Click here to enter text.	Click here to enter text.

List the two phone numbers you would like us to call first in the event that Blessed Sacrament School needs to contact you.
1.	Name:	Click here to enter text.	Phone Number:	Click here to enter text.
2.	Name:	Click here to enter text.	Phone Number:	Click here to enter text.

List two secondary contacts in case the primary contacts are unavailable.
Name	Relationship	Address	Phone
1.	Enter text.	Enter text.	Enter text.	Enter text.
2.	Enter text.	Enter text.	Enter text.	Enter text.

Should we be aware of anyone who is legally not permitted to pick up your child? ☐ Yes	☐ No

If so, we require court documents stating this.

Transportation (Choose One): My children Choose an item.