Super Kids’ Place (Arnold)
Emergency Evacuation Form

Please sign & return this form

I understand that in case of an emergency evacuation during Super Kids’ Place time my
child/ren __________________________ will walk to Asbury, on Church Rd.
Parents will pick up their children as soon as possible after being notified of the situation.

Parent’s Signature _________________________________

Home Address ____________________________________

Home Phone ________________Cell Phone_______________
Work Phone _________________________

Another Emerg. Contact _____________________________________