Emergency Card Form Emergency Card Child's Name:* First Last Please upload a good identification photo of your child. (You can bring one in to Appletree if you are unable to upload for some reason.)Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB. Child's Eye Color:*Child's Hair Color:*Child's Date Of Birth:* Parent/Guardian 1:* First Last Parent/Guardian 1 Email:* Parent/Guardian 1 Phone:*Parent/Guardian 1 Alternate Phone:Parent/Guardian 2: First Last Parent/Guardian 2 Email: Parent/Guardian 2 Phone:Parent/Guardian 2 Alternate Phone:Emergency Contact Person:* First Last Emergency Contact Person Phone:*Emergency Contact Person Alternate Phone:Doctor:* First Last Doctor Phone:*Child's Care Card Number:*Child's Allergies, Medications or Concerns:Approved Pickup Other Than Parent - FULL Name & RelationshipSignature*Your NameYour NameYour NameYour NameBy signing here you give permission for your child to be transported by ambulance in case of an emergency.
