410-549-1717 | The Legacy School serves students with dyslexia and language-based learning disabilities

Student Emergency Information

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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)
Parent/Guardian Name #2

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
MM slash DD slash YYYY
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