DAVIDIAN MARIAMIAN EDUCATIONAL FOUNDATION
Student Registration and Emergency Card
Legal Name:
Address:
Father's
Business Phone
Health problem required possible emergency, for example diabetes , bee string, other (specify)
School Name Grade Grade
Print name in Armenian
Home Phone Birth Date
Sex Birth Place
Mother's Name
Business Phone
I understand that emergency information is required by Education Code Section 49408 , and i will notify the school
IMMEDIATELY of any change. In case you are unable to reach me during any emergency, you or your agent are authorized
to contact, release, transport my child to any of following:
Name of Doctor:
Doctor's Address:
Adult relative,neighbor,friend in the local area
Phone Number:
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ID # ...................................
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Last Name
Firs Name
State
Number
Street
Street
Apt. Number
City
State
Zip Code
School
Armenian
Middle
City
Unit Number
Zip Code
Signature of Father, Mother or guardian
Name
Tel. #
Printable Form