Emergency Contact Sheet
Print this and stick it on the fridge. Fill in before your au pair arrives.
EMERGENCY CONTACTS & INFO
Family Information
Address: ____________________________________________
Home Phone: __________________________
Parents
Mom Name: ____________________ Mobile: ________________
Mom Work: ___________________ Phone: ________________
Dad Name: ____________________ Mobile: ________________
Dad Work: ___________________ Phone: ________________
Children
Child 1: ______________________ DOB: __________ Allergies: _______________
Child 2: ______________________ DOB: __________ Allergies: _______________
Child 3: ______________________ DOB: __________ Allergies: _______________
Medical
Pediatrician: ___________________ Phone: _______________
Dentist: ______________________ Phone: _______________
Nearest Hospital: _______________ Phone: _______________
Insurance Provider: ______________ Policy #: ______________
School & Activities
School Name: ___________________ Phone: _______________
After-School: __________________ Phone: _______________
Trusted Contacts
Neighbor: _____________________ Phone: _______________
Grandparent: __________________ Phone: _______________
Family Friend: ________________ Phone: _______________
Local Emergency Numbers
Police: __________
Fire: __________
Ambulance: __________
Poison Control: __________