Student Emergency Release Contact Information

YEAR & SECTION: __________________________

STUDENT FULL NAME PEOPLE WITH PERMISSION TO PICK CONTACT PARENTS INITIALS/
UP CHILD IN CASE OF EMERGENCY INFORMATION SIGNATURE
OR DISASTER

1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
1.
2.
3.
 Early Warning System
Contact Number

Section/s Adviser’s Name Contact # Class President/ Contact #

 Student-Teacher
Cynthia P. Dela Cruz
Principal

Mon Eric Lomeda

Focal Person

Lea Viri
Early Warning Chairman

Luisito S. Adaya Angelique De Leon Joy S. Angeles

Grade 7 Grade8 Grade 9 Grade 10
Chairman Chairman Chairman Chairman

Grade 7 Grade 8 Grade 9 Grade 10

Advisers Advisers Advisers Advisers

Class President Class President Class President Class President

per section per section per section per section

Students Students Students Students

 Parent-Teacher
Cynthia P. Dela Cruz
Principal

Mon Eric Lomeda

Focal Person

Lea Viri
Early Warning Chairman

Angelique
Luisito S. AdayaDe Leon Joy S. Angeles
GradeGrade8
7 Grade 9 Grade 10
Chairman
Chairman Chairman Chairman

Grade 7 Grade 8 Grade 9 Grade 10

Advisers Advisers Advisers Advisers

Classroom PTAClassroom PTA Classroom PTA Classroom PTA

President perPresident per President per President per
section section section section

Parents Parents Parents Parents