Parent name:_________________________

Phone number:__________________________

Address:__________________________________________

Emergency Phone:_____________ Cell Phone:________________
Pager:______________

Alternate Emergency Contact Person:______________________
Phone:________________

Location Where Parents Will Be:_______________________________________

Phone Number Where Parents Will Be: ______________________________

When parents will be returning: _____________________________________

Checklist:

First Aid Kit Located	Yes _____ No _____
Fire Extinguishers Located	Yes _____ No _____
Pen and Paper by Phone	Yes _____ No _____
Emergency Numbers by Phone	Yes _____ No _____
Walk Through Completed	Yes _____ No _____
Outside Lights On	Yes _____ No _____
Transportation To/From Job Arranged	Yes _____ No _____

Special Instructions from Parents: ______________________________________
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