• Family Emergency Contact
    Dear Parent/Guardian:

     

    Please complete and return to school as soon as possible.  It is very important to keep our records up-to-date and provides us with the proper procedure you wish us to take if emergency care is needed for your child(ren).  If any changes occur during the course of the school year, please call the school office with new information.

     

    Student                                                                                                  Birthdate                               

    Student                                                                                                  Birthdate                               

    Student                                                                                                  Birthdate                               

    Student                                                                                                  Birthdate                               

    Parent/Guardian information:

     

                    Mother                                                                                   Father                                                                   

                    Address                                                                                                                                                                

                    Home Phone                                                                                                                                                                                       

                    Work Phone                                                                                                                                                                        

                    Cell Phone                                                                                                                                                           

    Physician’s Name & Phone                                                                                                                                              

    Dentist’s Name & Phone                                                                                                                                                   

    Please list any allergies or special needs your child(ren) may have which we are not aware:

     

                                                                                                                                                                                                   

                                                                                                                                                                                                   

    Person(s) who will care for child(ren) in case a parent cannot be reached:

     

    Name                                                                                                     Phone                                                                   

     

    Name                                                                                                     Phone                                                                   

    **Parent permission to give Tylenol:                                                                                                              

    In the event of bad weather, listen to KBMW – 1450 AM for early dismissal and have arrangements made for young children to have a safe place to go if a responsible person will not be available at your home.  Please call the school immediately if your children are to be cared for at another home so we can inform the bus drivers.  Thank you.
     
    THE CAMPBELL-TINTAH SCHOOL DISTRICT DOES NOT DISCRIMINATE ON

    THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, SEX, AGE OR DISABILITY.

     

    “AN EQUAL OPPORTUNITY EMPLOYER”