Emergency Release FormEMERGENCY RELEASE FORM Student First Name* Student Last Name* Email*Authorized Person(s) to whom the student may be released regularly. Include parents if applicable. #1 Mother First & Last Name / Address & Phone Number #2 Father First & Last Name / Address & Phone Number #3 First & Last Name / Relationship / Address & Phone Number #4 First & Last Name / Relationship / Address & Phone NumberRelease in custody situations: for parents for whom custody is established by court order. #5 First & Last Name / Relationship / Address & Phone Number #6 First & Last Name / Relationship / Address & Phone NumberRelease in custody situations: for parents for whom custody is established by court order. Please provide information about student release. First & Last Name / Phone # / Relationship / Days of week, etc.
