Emergency Information Form

    Please fill out one form for each child registered at Saint Michael School.

    Religion/Race/Ethnicity

    In Case of Emergency

    Medical
    I hereby authorize you to contact my child's physician if I cannot be reached and such call is considered necessary. I also give permission to the school nurse to share information relevant to my child's health condition with appropriate school personnel as needed to meet my child's health and safety needs.
    In case of emergency, does the school have permission to take your child to the nearest hospital?

    Dismissal

    Please record how your child is transported from school in the afternoon:

    Parent/Guardian Signature

    ​Name of Parent / Guardian who filled out online form:
    By checking the box below, I am stating that all the information filled out on this form and is true and accurate:
​Saint Michael School
​21 Sixth Street   |  Lowell, Massachusetts 01850
Phone: 978-453-9511 Fax: 978-454-4104
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​"Saint Michael School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.”