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Safety-ID

SM

Child Identification Document

Because we care about the health and safety of our children

Personal Information

Medical Care Information

Name: _____________________ Nickname: __________________ SS#: _______________ Sex: ___ Date of Birth: _______________ Height: _______ Weight: _____ Hair color: __________________ Eye color: __________________

Doctor: ___________________ Doctors Phone: _____________ Dentist: ___________________ Dentist’s Phone: ____________ Pharmacy: _________________ Pharmacy Phone: __________

Home Information Street: ____________________ City: ______________________ State: _____ Zip: ____________ Email: _____________________ Home Phone: _______________ Mother’s Cell: _______________ Father’s Cell: ________________ Mother’s Name: _____________ Her work phone: ____________ Father’s Name: _____________ His work phone: _____________

School Information

Date of Photo: _____________

Identifying Features ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ____________________________ Ethnic Group: ________________ Child is verbal?

Yes

No

Can read/write? Yes

No

Language(s) spoken by child:

Medication Child is taking: _________________________ _________________________ _________________________ _________________________ _________________________ Child’s Blood Type: _________ Allergies: _________________ __________________________ __________________________ __________________________ Health Ins. Carrier: ___________ Insurance ID#: ______________ Insurance Group #: __________

Relatives/Neighbors

Name of Child’s school: ___________________________ ___________________________

Name: ____________________ Relationship: _______________

School Address: _____________

Phone: ____________________

Special Needs

School Phone: ______________

___________________________

Name: ____________________

School Bus Number: _________

___________________________

Relationship: _______________

Emergency Contact Person: __________________________ Contact Person’s phone #: __________________________

___________________________ ___________________________ ___________________________ ___________________________

Phone: ____________________ Name: ____________________ Relationship: _______________ Phone: ____________________

Attach photo and fill out form. Store in a secure location. Smartphone app available. Visit us at Safety-id.com for details

Available for iPhone and Android!

Safetyid Smartphone image  
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