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#3 - 20/21 Registration - Emergency Contacts & Releases

This form is REQUIRED for all families enrolling children at ICD Parish Preschool or K-8 School. 

Emergency Contacts Information

Please list 3 trusted adults, other than yourself, along with their relationship to your children and the best phone number to reach them during school hours.  This list is SEPARATE from your authorized pick-up list.


In case of Emergency, earthquake or other, I give the ICD School Staff permission to...*
Please check ONE of the following options.
Answer Required

Medical Emergency Releases:

In case of accident or serious illness, I request the school to contact me. In the event that the school is unable to reach me, the school may make whatever arrangements seem necessary.*
Answer Required
I hereby authorize the Immaculate Conception Catholic School Staff caring for my children to administer any medication and treatment in the event of a major disaster. In consideration, I agree to hold harmless and indemnify the Immaculate Conception Catholic School and its employees against all injuries arising out of these arrangements.*
Answer Required
Confirmation Email