BEC Emergency Card
4
Berean Education Center Date Completed _________ Emergency Card Revised _________ Child’s Name __________________________ Birthdate ________ Parents’ Names _________________________ Home Address ____________________________________ City __________________________ Zip _________ Alternate Address _____________________________ City _______________________________ Zip _________ Home Phone # ____________________________ Alternate Phone # __________________________ Father’s Employer __________________________________ Phone __________________ Hours ____________ Mother’s Employer _________________________________ Phone __________________ Hours _____________ Emergency contacts - (Persons who we may contact & may pick up your child if we cannot contact you.) Name ________________________________ Phone ___________________ Relationship __________________ Name ________________________________ Phone ___________________ Relationship __________________ People other than parents who have permission to pick up and drop off your child: Name _________________________________ Phone _________________ Relationship __________________ Name _________________________________ Phone _________________ Relationship __________________ People NOT authorized to pick up your child ______________________________________________________ (OVER)
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Emergency contact information form for Berean Education Center
Transcript of BEC Emergency Card
Berean Education Center Date Completed _________
Emergency Card Revised _________
Child’s Name __________________________ Birthdate ________ Parents’ Names _________________________
Home Address ____________________________________ City __________________________ Zip _________
Alternate Address _____________________________ City _______________________________ Zip _________
Home Phone # ____________________________ Alternate Phone # __________________________
Father’s Employer __________________________________ Phone __________________ Hours ____________
Mother’s Employer _________________________________ Phone __________________ Hours _____________
Emergency contacts - (Persons who we may contact & may pick up your child if we cannot contact you.)
Name ________________________________ Phone ___________________ Relationship __________________
Name ________________________________ Phone ___________________ Relationship __________________
People other than parents who have permission to pick up and drop off your child:
Name _________________________________ Phone _________________ Relationship __________________
Name _________________________________ Phone _________________ Relationship __________________
People NOT authorized to pick up your child ______________________________________________________
(OVER)
Berean Education Center Date Completed _________
Emergency Card Revised _________
Child’s Name ___________________________ Birthdate _________ Parents’ Names _______________________
Home Address ____________________________________ City __________________________ Zip _________
Alternate Address __________________________________ City __________________________ Zip _________
Home Phone # ____________________________ Alternate Phone # __________________________
Father’s Employer _________________________________ Phone __________________ Hours ____________
Mother’s Employer _________________________________ Phone __________________ Hours ____________
Emergency contacts - (Persons who we may contact & may pick up your child if we cannot contact you.)
Name ________________________________ Phone ___________________ Relationship __________________
Name ________________________________ Phone ___________________ Relationship __________________
People other than parents who have permission to pick up and drop off your child:
Name _________________________________ Phone _________________ Relationship __________________
Name _________________________________ Phone _________________ Relationship __________________
People NOT authorized to pick up your child ______________________________________________________
(OVER)
Physician ________________________ Address_____________________ Phone ________________________
Dentist __________________________ Address ____________________ Phone _________________________
Medical Problems ____________________________________________________________________________
Known Allergies _____________________________________________________________________________
Berean Education Center has my permission to secure medical help, including the services of the rescue squad or
the emergency room of the closest medical facility in the event of an emergency.
__________________________________________________ ____________________________Signature Date
I have read the BEC Parent Handbook and agree to the procedures and policies within.
Signature ______________________________________________ Date _________________
Any changes MUST be reported to the office as soon as they take place.
Physician ___________________________ Address_____________________ Phone ______________________
Dentist _____________________________ Address ____________________ Phone _______________________
Medical Problems _____________________________________________________________________________
Known Allergies ______________________________________________________________________________
Berean Education Center has my permission to secure medical help, including the services of the rescue squad or
the emergency room of the closest medical facility in the event of an emergency.
_______________________________________________ ____________________________
Signature Date
I have read the BEC Parent Handbook and agree to the procedures and policies
_________________________________________________ ____________________________
Signature Date
Any changes MUST be reported to the office as soon as they take place.
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