• Social

Civil Emergency Contact Form





Other siblings at Paparangi School:

Sibling’s Name

Sibling’s Name

Are you a one-parent family?
YesNo

New Entrant’s name: (required)

Room Number:

In the event of a serious emergency requiring the evacuation of the school premises, I authorise the following nominees to uplift our child/children from Paparangi School.
NB:Nominees should be within walking distance of the school in case of major disaster.

First Nominee
Relationship to childGrandparentFriendNeighbourOther
If other, please provide details

TitleN/AMrsMsMissMr

Name

Address:

Primary Contact Telephone NumberHomeWorkCellphone

Secondary Contact Telephone NumberHomeWorkCellphone

Second Nominee
Relationship to childGrandparentFriendNeighbourOther
If other, please provide details

TitleN/AMrsMsMissMr

Name

Address:

Primary Contact Telephone NumberHomeWorkCellphone

Secondary Contact Telephone NumberHomeWorkCellphone

Parent/Caregiver Verification
The information above is true and correct at the time of completion. I undertake to advise the school of any change in circumstances so that accuracy and contacts may be maintained.

Submitted by

Date

Confidentiality
This information is requested by Paparangi School in order to communicate with parents and caregivers to maintain the safety of our students as well as meeting the statutory requirements of the Ministry of Education. Information is held securely (consistent with the school’s privacy policy).