Emergency Contact SheetCall 911

in any life-threatening emergency

Poison control: (800) 222-1222

Police department Phone: _________________________________

Fire department Phone: _________________________________

Local emergency room Hospital name: ___________________________ Phone: _________________________________ Address: ________________________________

Doctor Name: _________________________________ Phone: _________________________________

Dentist Name: _________________________________ Phone: _________________________________

Family health insurance Company name: __________________________ Policy/group #: ___________________________

Child’s informationFull name: __________________________________Date of birth: ________________________________Weight: __________ as of (date) ________________Medical conditions: ______________________________________________________________________Allergies: ______________________________________________________________________________Other notes (fears, special needs): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Parent’s information Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________

Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________

Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________

Family, friends, and neighbors Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________

Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________

Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________

Name: ___________________________________ Relationship: ______________________________ Phone: ___________________________________ Cell: _____________________________________

Household information(alarm company, plumber, electrician, vet) Company : ________________________________ Contact name: _____________________________ Phone: ___________________________________

Company : ________________________________ Contact name: _____________________________ Phone: ___________________________________

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