Contact Card Form – St. John's Lutheran School

Family Name *
Home Address *
City, State Zip Code *
Home Phone Number *
Name of Father *
Father's Cell Phone Number *
Father's Place of Employment *
Father's Work Phone Number *
Name of Mother *
Mother's Cell Phone Number *
Mother's Place of Employment *
Mother's Work Phone Number *
School Communication Email *
Name of First Child *

First

Last
Grade Level of First Child *
Date of Birth of First Child *
Name of Second Child

First

Last
Grade Level of Second Child
Date of Birth of Second Child
Name of Third Child

First

Last
Grade Level of Third Child
Date of Birth of Third Child
Name of Fourth Child

First

Last
Grade Level of Fourth Child
Date of Birth of Fourth Child
Contact this person first in case of an emergency *
Relationship of this person to child(ren) *
Choose Home, Cell, or Work Number as method to contact this person. *

Include a phone number if not previously given.
Contact this person second in case of an emergency *
Relationship of this person to child(ren) *
Choose Home, Cell, or Work Number as method to contact this person. *

Include a phone number if not previously given.
Contact this person third in case of an emergency *
Relationship of this person to child(ren) *
Choose Home, Cell, or Work Number as method to contact this person. *

Include a phone number if not previously given.
Today's Date *
Signature of Parent/Guardian (Print Name Here) *