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EMERGENCY CONTACT FORM

indicates a required answer

IN THE EVENT OF AN EMERGENCY, WE WILL ADMINISTER TO THE NEEDS OF THE CHILD FIRST AND MAKE EVERY ATTEMPT TO CONTACT THE PARENTS AND EMERGENCY CONTACTS LISTED.
1. *

Family Name, Mom's Cell #,
2. *

Please list three EMERGENCY CONTACTS, other than yourself. List first and last name and cell number.
3. *

Do you know anyone here at TEC?
YES NO
4. *

IF SO, WHO?
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