Family Emergency Card Form

Emergency Cards must be filled out for each individual student. Once you have completed this form, if you have updates throughout the year, contact Maggie Leddy, Registrar at profile@hamlin.org

* denotes Required Fields.

Your Information

Parent 1 Information

Parent 2 Information

Emergency Contacts

In an emergency, when I or any other parent/guardian of this student cannot be reached, contact one of the following by phone. They are authorized to act in my absence, and will present identification to release my child from school.

Emergency Contact 1

Emergency Contact 2

Doctor Information
Does your child have any allergies, physical limitations, or medications?
Permission To Treat

If, in the opinion of a properly licensed and practicing physician, my daughter needs medical services which require my authorization or consent, I authorize and empower The Hamlin School to act as my agent to authorize service. I release The Hamlin School from any liability from incidents that may arise related to the initial medical need.

Permission to Use Image

I give permission for my child's image (video, photograph) to be used in publicity related to the school and on the Hamlin website, without listing their name.

Authorized For School Pick-Up

The following persons, who are not parents/guardians of this student, are authorized to pick-up my child from school.

Person 1

Person 2

Carpool Information

We agree to abide by the drop-off/pick-up rules published in the Student-Parent Handbook and to make these rules known to anyone I designate to pick-up my child.

Car 1 Information

Car 2 Information

Permission To Walk Home (Grades 5-8)

I give permission to my daughter to walk home from Hamlin after school.

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