Super Kids' Place (Belvedere)
Emergency Evacuation Form

Please sign and return with other forms:

I UNDERSTAND THAT IN CASE OF AN EVACUATION DURING SUPER
KIDS' PLACE , MY CHILDREN_______________________________
will walk to New Hope Church, 804 Windsor Rd. just opposite the school. Parents
will pick up their children as soon as possible after being notified of this situation.

PARENT'S SIGNATURE_____________________________________

HOME ADDRESS _________________________________________

HOME PHONE # __________________Cell Phone______________

ANOTHER EMERGENCY#____________________________________