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!