Parent(s) name(s):____________________________________________

Children's names and ages:

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Phone number:__________________________

Address:__________________________________________

Nearest Cross Streets: ____________________________________________

Phone Number Where Parents Will Be: ________________________________

Doctor: _________________________ Phone: _________________________

Hospital: _____________________________ Phone: ____________________

Poison Control Center: ________________________________

Neighbour: ______________________________ Phone: __________________

Location of smoke detector and fire extinguisher: ______________________

Location of first aid kit: ______________________________________________

Other Instructions: __________________________________________________
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