Emergency Health & Family Information Form

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Parent Information

Parent/Guardian1

First Last
Name *
Parent1 Home Address


Parent1 Business Information
Parent1 Business Address


Parent/Guardian2

First Last
Name

Parent2 Home Address


Parent2 Business Information
Parent2 Business Address


Student Information

Student1
SCDS Census

Each year, Sacramento Country Day School is asked to report the demographics of the student body to the National Association of Independent Schools (NAIS). In order to improve the accuracy of these statistics, please submit this data.



Student1 Address
Primary Address


Click here to enter additional address for student
Health Information





Physician Information (Required)









Student2
SCDS Census

Each year, Sacramento Country Day School is asked to report the demographics of the student body to the National Association of Independent Schools (NAIS). In order to improve the accuracy of these statistics, please submit this data.



Student2 Address
Primary Address


Click here to enter additional address
Health Information





Physician Information (Required)









Student3
SCDS Census

Each year, Sacramento Country Day School is asked to report the demographics of the student body to the National Association of Independent Schools (NAIS). In order to improve the accuracy of these statistics, please submit this data.



Student3 Address
Primary Address


Click here to enter additional address
Health Information





Physician Information (Required)








Additional Contacts

If parents are unavailable, list people authorized to pick up student(s). (Local contacts only.)

We'd like to know a little more about you. Please complete any portion of the following.

Parent/Guardian1
Parent1 Education
School Degree and Major
College
Graduate School
High School




Parent/Guardian2
Parent2 Education
School Degree and Major
College
Graduate School
High School




Please Read

In the event of an accident or other emergency at SCDS or on a field trip, when a parent is unavailable, I hearby authorize a representative of the school to make such arrangements as he or she considers necessary for my child(ren) to receive medical or hospital care, including essential transportation under such circumstances. I further authorize the physician I have named to undertake such care and treatment of my child(ren) as he or she considers necessary. In the event that said physician is not available at the time, I authorize such care and treatment to be performed by any licensed physician or surgeon.


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