STUDENT EMERGENCY MEDICAL/CONTACT INFORMATION FORM - hwdsb on 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the parent/guardian's surname, first name, and middle name in the designated fields.
3. Fill in the date of birth for the student to ensure accurate identification.
4. List emergency contacts in order of priority. Include their names, relationship to the student, and both preferred and alternate contact telephone numbers.
5. Indicate whether the student can be picked up by each contact by selecting 'Yes' or 'No' for each entry.
6. Provide any necessary medical information, including allergies and whether an Epipen is required. Note any other medical conditions or restrictions that may apply during the excursion.
7. For out-of-province/country excursions, complete the medical insurance provider details and proof of coverage section.
8. Finally, ensure that a parent/guardian signature and date are included to consent to emergency medical care if needed.

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