Free template
Daycare Emergency Contact Form — Free Digital Template
This is a daycare emergency contact form as one online form: both parents’ numbers, at least two emergency contacts who are not the parents, the child’s physician and insurance, known allergies and conditions, and signed consent for emergency medical treatment. Parents fill it in on a phone and sign on the screen. Free, and every field is editable before you send it.
No credit card. Every field is editable once it is in your account.
Last updated September 5, 2026
Enrollment packet — preview
5 sections · 30 fields · nothing here is submitted
Child
Child's full name (required)
Date of birth (required)
Classroom or group
Parents and guardians
Parent or guardian 1 — full name (required)
Relationship to child (required)
Mobile phone (required)
Work phone
Email address (required)
Parent or guardian 2 — full name
Parent or guardian 2 — mobile phone
Parent or guardian 2 — email address
Emergency contacts (not the parents)
Emergency contact 1 — full name (required)
Emergency contact 1 — relationship (required)
Emergency contact 1 — phone (required)
May this person pick up the child? (required)
- Yes
- No
Emergency contact 2 — full name (required)
Emergency contact 2 — relationship (required)
Emergency contact 2 — phone (required)
May this person pick up the child? (required)
- Yes
- No
Physician, insurance, and conditions
Primary care provider — name (required)
Primary care provider — phone (required)
Preferred hospital
Health insurance carrier and policy or member number
Known allergies (food, medication, insect, other)
Name the allergen, the reaction, and what staff should do.
Conditions staff should know about (asthma, seizures, diabetes, other)
Current medications
Emergency medical consent
I authorize the program to obtain emergency medical treatment for my child if I cannot be reached (required)
I will update this form whenever any contact or medical information changes (required)
Parent or guardian signature (required)
Date signed (required)
What's inside, and why each part is there
Requirements vary by state — check your state's licensing requirements before you send this to a family.
01 · Child
The form has to be usable by whoever is in the room when something happens, so the child’s identifying details sit at the top where a substitute can read them without opening a file.
02 · Parents and guardians
Licensing rules generally require a way to reach a parent during every hour the child is in care. Home, mobile, and work numbers cover the hours the mobile is in a locker.
03 · Emergency contacts (not the parents)
Most states require at least one emergency contact who is someone other than a parent, and inspectors look for it. Two is the common ask, in the order you should call them.
04 · Physician, insurance, and conditions
An emergency room asks for the physician and the insurance before anything else, and staff need allergies and conditions in front of them, not in a file cabinet. Keep this short; the medical form holds the detail.
05 · Emergency medical consent
Written consent for emergency medical care is what lets a hospital treat the child when a parent cannot be reached. It belongs on the same page as the numbers to call, so it travels with them on trips and drills.
Common questions
How often should a daycare emergency contact form be updated?
Whenever anything on it changes, and on a fixed schedule regardless — every six months is a common licensing rule, and annually is the minimum most programs use. Sending the form again as a link takes parents a minute on a phone, which is why digital forms get updated and paper ones don’t.
Do emergency contacts have to be people other than the parents?
In most states, yes — at least one contact who is not a parent, and many programs ask for two. The form here has two non-parent contacts and asks whether each may also pick the child up.
Is emergency medical consent part of the emergency contact form?
It should be. Consent for emergency treatment needs to be in the same place as the phone numbers so both travel together on field trips and during evacuations. This template puts the signed consent on the last section.
Where does the completed form go?
Into the child’s file in your account, as a PDF, the moment the parent submits it. If you keep child files in Records, the response is filed there automatically.
The AI builds this packet into your account, ready to edit and send.
Informational template — enrollment requirements vary by state; not legal advice. Check your state's licensing requirements for what your program must collect.