Name: ___________________________________ Section: ______________________

Name of teacher: __________________________ Date: ________________________

Family Emergency Plan #1

Household Information:
Family Name: __________________________________________________________________
Full Address:
______________________________________________________________________________
______________________________________________________________________________
Home Phone number: ___________________________________________________________

Parent 1: ____________________________________ Cellphone number: _______________

Facebook link: _________________________________________________________________
Parent 2: ____________________________________ Cellphone number: _______________
Facebook link: _________________________________________________________________
Guardian: ____________________________________ Cellphone number: _______________
Children 1: ____________________________________ Cellphone number: _______________
Facebook link: _________________________________________________________________
Children 2: ____________________________________ Cellphone number: _______________
Facebook link: _________________________________________________________________
Children 3: ____________________________________ Cellphone number: _______________
Facebook link: _________________________________________________________________

Emergency Contacts:
Out-of-Area Contact: ___________________________ Cellphone number: _______________
Facebook link:
Neighbor: ____________________________________ Cellphone number: _______________
Emergency Meeting Place:
______________________________________________________________________________
______________________________________________________________________________

Evacuation Routes:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Primary Evacuation Route:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Emergency Kit:
1. _________________ 11. _________________
2. _________________ 12. _________________
3. _________________ 13. _________________
4. _________________ 14. _________________
5. _________________ 15. _________________
6. _________________ 16. _________________
7. _________________ 17. _________________
8. _________________ 18. _________________
9. _________________ 19. _________________
10. _________________ 20. _________________

Special Considerations:
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________
Communication Plan:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Information Gathering:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Student signature over printed name

Father signature over printed name

Mother signature over printed name

Guardian signature over printed name