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Father's Name:

Mother's Name:
Home Address:
Home Phone Number:
Cell Phone #:
Work #'s:
PEDIATRICIAN:
Address:
Phone Number:
Pharmacy:
Phone Number:
DENTIST:
Address:
Phone Number:
FAMILY PHYSICIAN:
Address:
Phone Number:
SPECIALIST:
Address:
Phone Number:
Emergency Phone Numbers:
{911}
Poison Control:
School:
Nightime Pediatrics:
Emergency Contact:

our address:
our home #:
our cell #'s:
where we will be:

we will be back at:


in case of emergency:

special instructions:

name:
address:
e-mail
name:
address:
e-mail
name:
address:
e-mail
name:
address:
e-mail
name:
address:
e-mail
name:
address:
e-mail
name:
address:
e-mail
name:
address:
e-mail

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School Name
Address:
Phone #:
Principal:
Bus# & Driver:
Bus Phone #:
School Name
Address:

Phone #:
Principal:
Bus# & Driver:
Bus Phone #:
Teacher:
Classroom:

Room #:
Teacher:
Classroom:

Room #:
Teacher:
Classroom:

Room #:
Teacher:
Classroom:

Room #:

birthdays & anniversaries

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Independence Day

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Halloween

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Christmas Eve
Christmas

name

gift idea/size

price

date

Name:
Blood Type

Birthdate

Height

Weight

Right Hand Finger Prints

Left Hand Finger Prints

My Birthmarks and a few pieces of my hair:

Place of Birth Social Security

Hair color

Eye color

Doctor:
Specialist:
Address:
Phone #:
Preferred Hospital:
Last Seen

Doctor:
Specialist:
Address:
Phone #:
Preferred Hospital:
Last Seen

Doctor:
Specialist:
Address:
Phone #:
Preferred Hospital:
Last Seen

name:
prescription
date began:
instructions:
medical condition:
name:
prescription
date began:
instructions:
medical condition:
name:
prescription
date began:
instructions:
medical condition:
name:
prescription
date began:
instructions:
medical condition:
name:
prescription
date began:
instructions:
medical condition:

doctor:
how often:

doctor:
how often:

doctor:
how often:

doctor:
how often:

doctor:
how often:

Medical:
Policy#:
Mailing Address:
Agent:
Phone #:
Auto:
Policy#:
Mailing Address:
Agent:
Phone #:
Homeowners:
Policy#:
Mailing Address:
Agent:
Phone #:
Life:
Policy#:
Mailing Address:
Agent:
Phone #:
Other:
Policy#:
Mailing Address:
Agent:
Phone #:

License Plate#
VIN #

Vehicle
Year
Date

Mileage

Service

Cost

Location

name

date

event/idea

phone numbers & addresses

item

size/description

frome where?