Emergency Procedure Information

To view and print a pdf copy of the procedure click here.

Please complete the following form and return it to school as soon as possible.  Fill out one form per family, listing all children attending St. Joseph School.

1. ______________________________ Grade_____     4.___________________________Grade_______

2. ______________________________Grade_____      5.___________________________Grade_______

3. ______________________________ Grade_____     6,___________________________Grade_______

Father’s first & last name: _____________________________________Cell Ph.______________________

Mother’s first & last name: _____________________________________Cell Ph._____________________

Home address: ________________________________City______________St._______Zip_____________

Home Phone:______________________email address___________________________________________

Business phone (Dad’s)___________________________ (Mom’s) ________________________________

Family physician’s name: _______________________________ Office phone: _____________________

In case of illness at school, whom shall we call if you cannot be reached?

Name :____________________________Address: ________________________Ph:________________

Name: ____________________________Address:________________________Ph:_________________

In case of serious injury or sudden illness at school, may we call your family physician? Yes____  No____

If he/she is not available, another local physician?   Yes_____ No______

ALLEGERIES: 

______________________________________________________________________________________

In case of accident or injury at school, you have my permission to administer ordinary first-aid including the application of disinfectant, Band-Aids, etc.

Parent’s signature:__________________________________________

Parent’s signature:__________________________________________

Special Comments: