Free printable emergency contact form for daycare.

One sheet per child. Keep a copy where staff can reach it fast, and take one on every trip.

Program name (optional)

It prints at the top of the form.

Emergency contact form

Program

Child’s name

Date of birth

Room or group

Home address

Parents and guardians
Name	Relationship	Cell phone	Other phone	Email

Other emergency contacts, in the order to call them
Name	Relationship	Phone	Other phone	May pick up the child

Doctor and insurance

Doctor’s name

Doctor’s phone

Dentist’s name

Dentist’s phone

Hospital the family prefers, if any

Insurance company and policy number

Health

Allergies

Medicines

Health conditions staff should know about

In an emergency, I give permission for staff to get medical care for my child.

Parent or guardian signature

Date

Free printable form from bloomily.app/tools/forms

How to use this form

Ask families to fill it in before the first day.
Keep one copy by the phone and one in the emergency bag.
Take a copy on every field trip.
Ask families to update it when a phone number changes.
Check it with each family at least once a year.

Check your state’s rules

Licensing rules decide which emergency details you keep, and how often you update them. Check your state’s rules.

Find your state’s licensing page

Questions, answered

How many emergency contacts should a family list?

Two adults besides the parents, when they can. Your state may set its own number.

How often should we update emergency contacts?

Whenever something changes, and at least once a year. Re-enrollment is a good time to check.

See it with your name on the door.

Get started

or book a demo

Run more than one kind of program? Talk to us.