Address:____________________Nearest cross street: __________________
Parents' Phone #:___________________________________________
Expected return time: ______________________________________
Emergency Number (Police/Fire) _____________________________
Doctor's Name_______________________________________________
Doctor's Phone Number ______________________________________
Poison Control Center Hotline 800-222-1222
Neighbor's Name_____________________________________________
Neighbor's Phone ___________________________________________
Child's Name: ________________________ Age:_________________
Allergies or Special Instructions: _____________________________
Child's Name: ________________________ Age:_________________
Allergies or Special Instructions: _____________________________
Child's Name: ________________________ Age:_________________
Allergies or Special Instructions: ______________________________
Areas off limits____________________________________________
Message to give if someone calls: ____________________________
____________________________________________________________
What to do about visitors: ____________________________________
____________________________________________________________
Guidelines for TV/computer use: ________________________________
____________________________________________________________
Location of fire extinguisher: _________________________________
Location of flashlights:____________________________________
Evacuation route if the smoke detector goes off: _______________
____________________________________________________________
Other: _______________________________________________________
____________________________________________________________