Arizona dhs bureau 2026

1. Click ‘Get Form’ to open the Emergency, Information and Immunization Record Card in the editor.
2. Begin by entering your child's name at the top of the form. Ensure that you also update the date and provide the home address, including street, city, state, and zip code.
3. Fill in the date of birth and home phone number. Indicate your child's sex by selecting either 'male' or 'female'.
4. Provide your name as the parent or guardian along with your contact details, including both home and cell phone numbers if applicable.
5. List at least two individuals authorized to collect your child in case of an emergency. Include their names and contact telephone numbers.
6. Complete the medical care authorization section by providing a health care provider's name and contact number.
7. Fill out any allergies or medical conditions your child may have, specifying necessary precautions.
8. Finally, review all information for accuracy before signing and dating the form at the bottom.

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