Broward County Public Schools Student Emergency Contact Card 2015-2026
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Broward County Public Schools Student Emergency Contact Card This form shall be updated every year. School For office use only Medical Court Order Special Needs Other Student Date enrolled In the case of an emergency it is imperative that the school be able to reach the student s parent as defined below. Please fill in the information on both sides of this card carefully and accurately. Please use ink and print clearly. The names of both parents of a student as defined in the Section 1000. 21 5 Florida Statutes the registering parent and the non-registering parent of a student shall be listed on the emergency contact card as persons authorized to pick up the child from school except where a court order has revoked the parental rights and a certified copy of such court order has been provided to the school office. Both parents shall designate on the Emergency Contact Card those persons authorized to pick their child up from school* No parent shall delete or in any way alter the names provided by the other parent on the Emergency Contact Card. Registering Parent Other Parent Gender Home Address City State Zip Home Phone Mailing Address if different from above Date of Birth Student lives with Check any that apply to student residence Middle Has student changed address since last registration Last First Employer Work Phone Female Male Yes Grade Level / Is there a court order on file that prevents a parent from having contact with the student No No If yes contact school* Email Cell Phone Authorized Release/ Contact Please list the names of persons to whom we may release your child or whom we may contact if we cannot reach you. NO STUDENT WILL BE RELEASED TO ANYONE OTHER THAN THE PERSONS LISTED BELOW* In selecting someone to whom you authorize the release of your child consider Is this person prepared to handle any special medical needs required by your child I/We hereby authorize contact with release of emergency related information or release of the student to the following persons in the event of illness evacuation or other emergency that may occur while the student is in school* Name Relationship Work or Cell Phone I declare that the information on this card is true and correct. I will notify the school office immediately of any changes. Signature Date Non-registering Parent Authorized Release/Contact Student Identification Number Teacher elementary school only Grade This section may be completed only by the non-registering parent in order to designate additional persons who may pick up the student. The registering parent may not alter this section of this card. The non-registering parent may not alter any other portion of this card. Form 4172 Revised 05/15 The personal information you provide on this form will be kept confidential in a protected area and only used and disclosed by school staff on a need-to-know basis. Student Name Does your child take medication Medication Health Insurance Information Vision and Hearing If your child requires medication at school all medication sent to the school must be in original prescription container with a current date and the child s name.
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What is the Broward County Public Schools Student Emergency Contact Card
The Broward County Public Schools Student Emergency Contact Card is a vital document designed to ensure the safety and well-being of students. This card contains essential information about a student, including emergency contacts, medical conditions, and other pertinent details that school officials may need in case of an emergency. By having this information readily available, schools can respond quickly and effectively to any situation that may arise, ensuring that students receive the appropriate care and support.
How to use the Broward County Public Schools Student Emergency Contact Card
Using the Broward County Public Schools Student Emergency Contact Card is straightforward. Parents or guardians fill out the card with accurate information regarding emergency contacts, medical history, and any special instructions. Once completed, the card should be submitted to the school administration. It is crucial to keep this information updated, especially when there are changes in contact details or medical conditions, to ensure that school personnel can reach the right individuals when needed.
Steps to complete the Broward County Public Schools Student Emergency Contact Card
Completing the Broward County Public Schools Student Emergency Contact Card involves several important steps:
- Gather necessary information, including names, phone numbers, and addresses of emergency contacts.
- Include any medical conditions or allergies that the school should be aware of.
- Provide additional instructions if required, such as preferred medical facilities or specific care instructions.
- Review the information for accuracy before submission.
- Submit the completed card to the school office, ensuring it is filed correctly.
Key elements of the Broward County Public Schools Student Emergency Contact Card
The Broward County Public Schools Student Emergency Contact Card includes several key elements that are essential for effective emergency response:
- Student Information: Full name, grade, and student ID.
- Emergency Contacts: Names, relationships, and contact numbers of individuals who can be reached in case of an emergency.
- Medical Information: Details about allergies, chronic conditions, and medications.
- Parental Consent: Signature or acknowledgment from a parent or guardian, indicating that the information provided is accurate.
Legal use of the Broward County Public Schools Student Emergency Contact Card
The Broward County Public Schools Student Emergency Contact Card serves a legal purpose in ensuring that schools have the necessary information to act in the best interest of students during emergencies. The information provided is protected under privacy laws, including the Family Educational Rights and Privacy Act (FERPA). Schools must handle this information with care, ensuring it is only accessible to authorized personnel who require it for the safety and well-being of the students.
How to obtain the Broward County Public Schools Student Emergency Contact Card
Obtaining the Broward County Public Schools Student Emergency Contact Card is a simple process. Parents or guardians can typically request the card through the school’s administrative office or download it from the school district's official website. It is advisable to obtain the card at the beginning of the school year or whenever there is a change in the student's status, such as enrollment in a new school or grade level.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 Broward County Public Schools Form 4172 [2015-05] 2015 | 4.8 Satisfied (8092 Votes) | |
| IRS W-9 2023 | 4.8 Satisfied (346 Votes) | |
| IRS W-9 2022 | 4.8 Satisfied (346 Votes) | |
| IRS W-9 2021 | 4.8 Satisfied (346 Votes) | |
| IRS W-9 2020 | 4.8 Satisfied (346 Votes) | |
| IRS W-9 2019 | 4.8 Satisfied (346 Votes) |
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- Choose My Signature.
- Decide on what kind of eSignature to create. There are three variants; a typed, drawn or uploaded signature.
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After that, your broward county public schools student emergency contact card is ready. All you have to do is download it or send it via email. airSlate SignNow makes eSigning easier and more convenient since it provides users with a range of additional features like Merge Documents, Add Fields, Invite to Sign, and so on. And due to its multi-platform nature, airSlate SignNow can be used on any device, personal computer or mobile, regardless of the operating system.
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The Broward County Public Schools Student Emergency Contact Card is a vital document that allows parents and guardians to provide essential contact information for their children in case of emergencies. This card ensures that schools can quickly signNow the appropriate contacts during critical situations, enhancing student safety and security.
You can obtain the Broward County Public Schools Student Emergency Contact Card by visiting the official Broward County Public Schools website or contacting your child's school directly. Schools typically provide guidance on how to fill out and submit the card to ensure it is processed correctly.
The Broward County Public Schools Student Emergency Contact Card includes fields for multiple emergency contacts, medical information, and any special instructions for your child. This comprehensive approach ensures that the school has all necessary information readily available during emergencies.
There are no costs associated with obtaining the Broward County Public Schools Student Emergency Contact Card. It is a free service provided by the school district to ensure the safety and well-being of students.
It is advisable to update the Broward County Public Schools Student Emergency Contact Card at the beginning of each school year or whenever there are changes to your contact information or your child's medical needs. Keeping this information current ensures that the school can signNow the right people in an emergency.
Yes, many schools within Broward County Public Schools offer the option to submit the Student Emergency Contact Card electronically using platforms like airSlate SignNow. This allows for a quick and efficient way to ensure that your child's emergency information is submitted and accessible.
The Broward County Public Schools Student Emergency Contact Card provides peace of mind for parents, knowing that their child's safety is prioritized. It streamlines communication in emergencies, ensuring that the right contacts are notified promptly, which can be crucial in critical situations.
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