IMPACT Contact Information

indicates a required answer

EMERGENCY CONTACTS

1. *	Student's Name

2. *

My child meets the requirements to attend WACHE School through the IMPACT Drop Off Program.

(3 required)

My child is at least 14 years old.		My child is in 9th-12th grade.
I have received email permisssion to join.

3. *	Contact Person #1. Please provide your name, relationship to the child, and cell phone number to be called in case of an emergency while your child is at WACHE School.

4. *	Contact Person #2: Please provide the name, relationship to the child, and cell phone number to be called in case of an emergency while your child is at WACHE School if you cannot be reached.

5. *	Contact Person #3. Please provide the name, relationship to the child, and cell phone number of the contact person #3 to be called in case of an emergency while your child is at WACHE School and you and contact person #2 cannot be reached.