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

<<	May 2023	>>
	1	2	3 SJS OPEN HOUSE 5:30-7:30PM	4	5 First Friday - Early Dismissal… First Friday Mass	6
7	8	9	10	11 HSA Meeting with Old Saybrook's…	12 Crowning of Mary	13 First Holy Communion
14	15	16 Band Concert Tuesday May 16th…	17 SJS SPRING CONCERT 6:30 PM	18 Beauty & the Beast Cast/Crew…	19	20
21	22	23	24	25	26 Field Day	27
28	29 Memorial Day - No School	30	31