St. John School Student Emergency Contact Information

Family Last Name

Your Email

Street

City

State

Zip

Student #1 Name

Please list all students in family at SJS

Student Date of Birth

Grade

Allergies (Yes/No)

If YES to ALLERGIES, please list

Student #2 Name

Student Date of Birth

Grade

Allergies (Yes/No)

If YES to ALLERGIES, please list

Student #3 Name

Student Date of Birth

Grade

Allergies (Yes/No)

If YES to ALLERGIES, please list

Student #4 Name

Student Date of Birth

Grade

Allergies (Yes/No)

If YES to ALLERGIES, please list

Parent/Guardian #1 Name

First & Last Name

Relationship

Lives with Child (Yes/No)

Home Phone

Cell Phone

Employer

Email

Parent/Guardian #2 Name

Relationship

Lives with Child (Yes/No)

Home Phone

Cell Phone

Employer

Email

Student's Physician

Physician's Phone

Student's Dentist

Dentist's Phone

In the event of a serious medical emergency or accident, and I cannot be reached, I authorize the school personnel to have my child treated by a readily available physician, hospital or emergency facility.

Yes No

Parent/ Guardian Name

Date

<<	April 2024	>>
	1 No School - Easter Monday	2	3	4	5	6
7	8 No School - Spring Break	9 No School - Spring Break	10 No School - Spring Break	11 No School - Spring Break	12 No School - Spring Break	13
14	15	16	17	18	19	20
21	22 NWEA Map Testing	23 NWEA Map Testing	24 NWEA Map Testing	25 NWEA Map Testing 6:30 PM - PTO Meeting	26 Progress Reports Issued NWEA Map Testing	27
28	29 NWEA Map Testing	30 NWEA Map Testing