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) 
________________________________________