The Richard Pate School

 

 

 

 

 

SEPTEMBER  2007

 

 

 

Name of child: …………………………………………………………  Class: …………….

 

 

 

UPDATE OF EMERGENCY CONTACT NUMBERS

 

Please update my child’s records with the following emergency contact telephone numbers:

 

Name: …………………………………………………  No. …………………………….

 

Name: …………………………………………………  No. ……………………………..

 

Name: …………………………………………………  No. ……………………………..

 

e-mail: ………………………………………………………………………………………

 

 

 

 

NEW MEDICAL CONDITION:  ……………………………………………………………

 

………………………………………………………………………………………………..

 

………………………………………………………………………………………………..

 

 

 

 

SPECIAL DIETARY REQUIREMENTS: …………………………………………………….

 

…………………………………………………………………………………………………….

 

……………………………………………………………………………………………………..

 

 

 

Signed: ……………………………………………………………..  Date: ……………………

                              (Parent / Guardian)