Does your child have any activity restrictions while at school? Yes No If yes, please describe: Emergency Contacts: Please prioritize 1,2,3, in the order the calls are to be placed: Name Relationship Home Phone Work Phone Cell Phone E-Mail Number Number Number 1. 1. 1. 1. 1. 1. 2. 2. 2. 2. 2. 2. 3. 3. 3. 3. 3. 3. Identify the preferred method of communication, for non-emergency situations Phone call Text Email Communication book/agenda Other; please specify: Additional Information: Designated school staff with tube feeding training: (to be completed by school staff) 1. 4. 2. 5. 3. 6.
Does your child have any activity restrictions while at school? Yes No If yes, please describe: Emergency Contacts: Please prioritize 1,2,3, in the order the calls are to be placed: Name 1. 2. 3. Relationship 1. 2. 3. Home Phone Number 1. 2. 3. Work Phone Number 1. 2. 3. Cell Phone Number 1. 2. 3. E-Mail 1. 2. 3. Identify the preferred method of communication, for non-emergency situations Phone call Text Email Communication book/agenda Other; please specify: Additional Information: Designated school staff with tube feeding training: (to be completed by school staff) 1. 2. 3. 4. 5. 6.
health%20care%20and%20emergency%20plans%20-%20tube%20feeding%20june%202015.docx