Emergency Form Student InformationChild's Name* First Last Days*MWF NurseryTTH Nursery5 Day PreschoolTKKindergartenClass*MWF Blue WhalesTTH Blue WhalesMWF StarfishTTH Starfish5 Day Preschool Penguins5 day Preschool Seahorses5 Day Preschool OtterTK TeddiesTK KoalasKindergartenBirth Date* MM DD YYYY Gender*MaleFemaleFirst Parent Name* First Parent Cell Phone*First Parent Email* Second Parent Name Second Parent Cell PhoneSecond Parent Email Home Phone*Emergency Contact InformationFirst Contact Name* Relationship*First Contact Phone*Second Contact Name* Relationship*Second Contact Phone*Third Contact Name* Relationship*Third Contact Phone*Medical InformationCurrent Medications*Allergies*Other Health Issues*Please check the following.* In case of illness, accident or emergency, we consent to medical emergency care to our child (children) that may be deemed necessary by any physician, hospital, or St. James' Parish Day School employee without obtaining further consent. In case of illness, accident or emergency, we DO NOT consent to medical emergency care to our child (children) that may be deemed necessary by any physician, hospital, or St. James' Parish Day School employee without obtaining further consent. Field Trip AuthorizationPlease check the following.* My child (children) has permission to participate in field trips during the school year My child (children) DOES NOT have permission to participate in field trips during the school year