Emergency Contact Sheet Call 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: _________________________________ Denst Name: _________________________________ Phone: _________________________________ Family health insurance Company name: __________________________ Policy/group #: ___________________________ Child’s informaon Full name: __________________________________ Date of birth: ________________________________ Weight: __________ as of (date) ________________ Medical condions: ___________________________ ___________________________________________ Allergies: ___________________________________ ___________________________________________ Other notes (fears, special needs): _______________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ Parent’s informaon Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________ Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________ Name: ____________________________________ Phone: ____________________________________ Cell: ______________________________________ Family, friends, and neighbors Name: ___________________________________ Relaonship: ______________________________ Phone: ___________________________________ Cell: _____________________________________ Name: ___________________________________ Relaonship: ______________________________ Phone: ___________________________________ Cell: _____________________________________ Name: ___________________________________ Relaonship: ______________________________ Phone: ___________________________________ Cell: _____________________________________ Name: ___________________________________ Relaonship: ______________________________ Phone: ___________________________________ Cell: _____________________________________ Household informaon (alarm company, plumber, electrician, vet) Company : ________________________________ Contact name: _____________________________ Phone: ___________________________________ Company : ________________________________ Contact name: _____________________________ Phone: ___________________________________ penrosestfrancis.org