Medical Emergency Form

Prove You Are A Human: What is 2 + 4?*
Student Name*
First Last
List any medical problems your child has:
List any medications your child will need while at Fanfare:
List any allergies that may cause your child difficulty (such as foods, bees, etc):
Parent/Guardian Name:*
First Last
Emergency Contact Name:*
First Last
Emergency Contact Phone:*
Who will be bringing and picking up your child?*
Name
This field is for validation purposes and should be left unchanged.