Student Emergency Contact Information

All fields below are required. Please place an N/A for not applicable if needed.
Student Information
Help for Birthdate This information will not be given out. mm/dd/yyyy
Help for Student Home E-mail address (not school email address)
Where parent/guardian can be reached if not at home:
Parent/Guardian Portion
I hereby grant permission for the above student to participate in district approved, class related field trips supervised by the instructor.
I hereby grant Eaton RESA Career Preparation Center, Lansing Community College, Davenport University, AIS Construction, Olivet College, Potter Park Zoo or Farm Bureau permission to photograph/videotape my child as they deem necessary for school use and/or media release.
I hereby grant permission for my student to be transported by an Eaton RESA staff member, when necessary.
In case of accident or serious illness, if the school is unable to reach me, I hereby authorize the school to call the physician indicated below and to follow instructions given. If it is impossible to contact this physician the school may make whatever arrangements deemed necessary. Please give emergency names other than parents.
Help for Signature Please write your legal name on this line in place of a signature.
mm/dd/yyyy
Eaton RESA does not discriminate on the basis of race, color, national origin, sex, (including sexual orientation and transgender identity) disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, “Protected Classes”), in its programs and activities, including employment opportunities. In addition, arrangements can be made to ensure that the lack of English language proficiency is not a barrier to admission or participation. Civil Rights Coordinators are located at 1790 E. Packard Hwy, Charlotte Michigan to handle inquiries regarding the nondiscrimination policies and grievance procedures. Telephone (517) 543-5500.