emergency contact sheet - centura.org · emergency contact sheet call 911 in any life-threatening...
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Emergency Contact SheetCall 911
in any life-threatening emergency
Poison control: (800) 222-1222
Police department Phone: _________________________________
Fire department Phone: _________________________________
Local emergency room Hospital name: ___________________________ Phone: _________________________________ Address: ________________________________
Doctor Name: _________________________________ Phone: _________________________________
Dentist Name: _________________________________ Phone: _________________________________
Family health insurance Company name: __________________________ Policy/group #: ___________________________
Child’s informationFull name: __________________________________Date of birth: ________________________________Weight: __________ as of (date) ________________Medical conditions: ______________________________________________________________________Allergies: ______________________________________________________________________________Other notes (fears, special needs): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Parent’s information Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________
Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________
Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________
Family, friends, and neighbors Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________
Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________
Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________
Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________
Household information(alarm company, plumber, electrician, vet) Company : ________________________________ Contact name: _____________________________ Phone: ___________________________________
Company : ________________________________ Contact name: _____________________________ Phone: ___________________________________
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