Super Kids Place ( Point Pleasant )
Emergency Evacuation Form
Please Sign and return this form:
I understand that in case of an emergency evacuation during Super Kids' Place time my child/ren
______________________________________________ will walk to Good Shepard Catholic
Church across from school. Parents will pick up their children as soon as possible after being
notified of the situation.
Parent's Signature_________________________________________________________
Home Address___________________________________________________________
Home Phone Number_____________________
Work Number______________________
Cell Phone Number________________________
Another Emergency Contact (Name and Number)
________________________________________
Emergency Evacuation Form
Please Sign and return this form:
I understand that in case of an emergency evacuation during Super Kids' Place time my child/ren
______________________________________________ will walk to Good Shepard Catholic
Church across from school. Parents will pick up their children as soon as possible after being
notified of the situation.
Parent's Signature_________________________________________________________
Home Address___________________________________________________________
Home Phone Number_____________________
Work Number______________________
Cell Phone Number________________________
Another Emergency Contact (Name and Number)
________________________________________