Student Emergency Information

Please fill out the emergency information form below.

Student Information

Student Name(Required)
MM slash DD slash YYYY

Parent/Guardian Information

Parent/Guardian Name #1(Required)
Address(Required)
Parent/Guardian Name #2
Address

Emergency Contact Information if Parents are Unreachable

Emergency Contact Name #1(Required)
Emergency Contact Name #2

Names of People Allowed to Pick Up Child

Name
Name
Name
Accepted file types: jpg, gif, png, andpdf, Max. file size: 256 MB.
Please upload a photo of your child. Photos will be used in the school directory. The school directory is only available for parents of The Legacy School students.
MM slash DD slash YYYY