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Emergency Contact · Popular

Childcare Emergency Contact Form for Parents & Guardians

Easily collect parent, guardian, and emergency contact details for children in your childcare center with this ready-to-use form template.

Use This Template Free Preview

Cloud theme

formbuilder.ai/f/childcare-center-parent-guardian-emergency-contact-information-form

Childcare Center Parent & Guardian Emergency Contact Information Form

Child's Full Name

· · ·

Child's Date of Birth

· · ·

Classroom / Group Name

· · ·

Submit

The Childcare Center Parent & Guardian Emergency Contact Information Form is an essential tool for daycare centers, preschools, and childcare facilities of all sizes. It enables staff to quickly capture critical information about each child, including known allergies, current medications, and primary care physician details, ensuring every child's safety and wellbeing are prioritized from day one.

Designed for childcare administrators and teachers, this form collects comprehensive contact information for both primary and secondary parents or guardians, along with at least one additional authorized pickup person. In the event of an emergency or unexpected situation, staff can act swiftly with all the necessary details at their fingertips, minimizing risk and confusion.

By digitizing this process with an online form, childcare centers eliminate paper-based inefficiencies, reduce data entry errors, and store information securely. The template is fully customizable to meet your facility's specific requirements, making it easy to add, remove, or rearrange fields. Give parents peace of mind and keep your staff prepared with a reliable emergency contact solution.

3 Pages

25 Questions

~8min To complete

Free No credit card needed

Field types Phone ×6 Full Name ×5 Short Text ×5 Single Choice ×2 Date Long Text Email Address singlecheckbox termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Child Information 7 questions

Child Information

1 Child's Full Name * Full Name

2 Child's Date of Birth * Date

3 Classroom / Group Name Short Text

4 Known Allergies or Medical Conditions Short Text

5 Current Medications & Dosage Instructions Long Text

6 Pediatrician / Doctor's Name Short Text

7 Doctor's Phone Number Phone

Page 2 Parent / Guardian Contact Details 9 questions

Parent / Guardian Contact Details

Please provide contact information for the primary and secondary parent or guardian.

1 Primary Parent / Guardian Full Name * Full Name

2 Relationship to Child * Single Choice

3 Primary Phone Number * Phone

4 Alternate Phone Number Phone

5 Email Address * Email

6 Home Address * Address

7 Secondary Parent / Guardian Full Name Full Name

8 Relationship to Child Single Choice

9 Secondary Parent / Guardian Phone Number Phone

Page 3 Emergency Contacts & Authorization 9 questions

Emergency Contacts

Please list at least one additional person authorized to pick up your child in case neither parent/guardian can be reached.

1 Emergency Contact 1 — Full Name * Full Name

2 Relationship to Child * Short Text

3 Emergency Contact 1 — Phone Number * Phone

4 Emergency Contact 2 — Full Name Full Name

5 Relationship to Child Short Text

6 Emergency Contact 2 — Phone Number Phone

7 I authorize the childcare center to seek emergency medical treatment for my child if I cannot be reached. * singlecheckbox

8 I confirm that all information provided is accurate and I agree to update the center promptly if any details change. * termsandconditions

9 Parent / Guardian Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.