|
Print this form from your
computer and have someone
from the family you are sitting for fill it out for you!
It could make the difference in an emergency.
FOR LIFE THREATENING EMERGENCIES:
CALL 911
FAMILY
NAME:
_____________________________________________________
CHILDREN'S NAMES:
______________________________________________AGE:_______________
______________________________________________AGE:_______________
______________________________________________AGE:_______________
______________________________________________AGE:_______________
FAMILY
ADDRESS:_________________________________________________
NEAREST
CROSS STREETS:_________________________________________
NUMBER TO
CONTACT PARENTS:_____________________________________
DOCTOR'S
NAME:__________________________PHONE:__________________
HOSPITAL:________________________________PHONE:__________________
POISION
CONTROL CENTER (in Porter County):
800- 382-9097
____________
NEIGHBOR
TO CONTACT FOR HELP:___________________________________
NEIGHBOR
PHONE NUMBER:_________________________________________
ADDITIONAL
INSTRUCTIONS:_________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________ |
