Emergency Information

Ask an adult to fill out this form.  Then put it in a safe place where you can get to it in an emergency. 

Fire: _________________________________

Police: _______________________________

Poison Control: _______________________

Doctor (name and phone number): ________________________

                                                                    ________________________

Where Parents can be reached: ___________________________

Full Address where you are babysitting:

          Street: __________________________

          Town: __________________________

          Phone: __________________________

Neighbors to contact (name, address, and phone):

          Name: ___________________________

          Address: _________________________

          Phone: ___________________________

Other instructions: ___________________________

   ___________________________

   ___________________________