Super Kids’ Place (Jones)
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 Woods Memorial Church in Severna Park.  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 _________________________________________________________