Kids can run into trouble any time! A food allergy could flare up, an illness, a playground injury, or maybe the child needs to be picked up earlier than expected. Such occurrences in a daycare aren’t very uncommon, and you need one place to tell you who to contact.
A Daycare Emergency Contact Form collects all of this. It’s a standard document that childcare centers and early childhood programs keep on file for every child. This document pulls all the details staff may need in an emergency to act quickly and contact the right person.
A complete childcare emergency contact form clearly lists parent/guardian contact information, emergency contacts who can step in if the primary guardians are unavailable, and officially records parents’ authorization for emergency medical treatment when and if they can’t be reached.
WordLayouts’ daycare emergency contact form includes all of these and also records key medical information for the child, including allergies, chronic conditions, and medications. With all this information, our template helps staff maintain a compliant record, reach families faster, respond to time-sensitive situations more effectively, and support first responders with accurate details.
Each section is in line with what most licensing guidelines expect and keeps important information easy to find, so there’s no delay in notifying families when something goes wrong.
What’s in This Form
Our Daycare Emergency Contact Form consists of seven sections, covering all the details you might need in a crisis.
Child information
At the top of the form are all the basic identifying details about the child, including:
- Full name
- Date of birth
- Gender
- Home address
- City, state, ZIP code
This information, right at the top, helps daycare staff to quickly and correctly identify the child and match them to the right file, especially in larger centers or when emergency responders are involved.
Note that the date of birth is particularly important here because age often affects medical decisions, such as medication dosage.
Parent/guardian contact information
This is the first place staff look when a child becomes ill or injured, needs an early pick-up, or encounters another mishap. It lists the following details for two contacts. You’ll find blocks for Parent/Guardian #1 and Parent/Guardian #2, and fill in the following details in:
- Name
- Relationship to the child
- Contact information (address, phone number (up to two; personal and work), email (for follow-ups))
This section confirms that the institute is reaching out to the right people (who have legal responsibility for the child), and in case one number doesn’t work, they can reach out to the parent/guardian’s second contact without wasting time.
Authorized pick-up individuals(s)
In this part, mention adults who are authorized by parents or guardians to pick the child from daycare, in addition to parents or guardians. For each of the two persons, the form provides space for:
- Name
- Relationship with the child
- Address
- Phone number
Many centers require a list of approved pickup adults as part of their safety procedures, so children are only released to people the family has identified in advance. This authorized person could be anyone the parents trust with occasional pickups, such as close relatives, grandparents, or regular drivers. This information comes in handy if the parents are delayed or there’s another issue regarding pickup.
Authorized additional emergency contacts
Sometimes you can’t reach anyone in an emergency, neither the primary caretaker’s parents/guardians nor the other authorized individuals. This section lists two additional people the family trusts their child with in those situations.
For each emergency contact, the form collects:
- Name
- Relationship to the child
- TWO Active phone numbers
Persons listed here are the center’s backup plan when repeated calls to parents go unanswered. They can also help with reunifications after bigger emergencies, like building evacuations or local disasters.
Medical information (optional)
This is where families can share any health-related details that might affect how staff respond in an emergency, such as:
- Preferred pediatrician and contact details that can be handed directly to paramedics or emergency-room staff so they can coordinate care.
- Medical conditions, if any (for example, asthma, diabetes, seizure disorders, chronic conditions)
- Known allergies, if any (food, medication, environmental)
- Other relevant notes, if any, parents can mention details about urgent care their child in distress might need. This includes noting where the inhaler or EPIPen is kept, etc.
There is also space for emergency medical instructions, where a healthcare provider can note symptoms or warning signs to watch for (such as signs of an asthma attack coming), suggest what to do if the symptoms occur, and recommend preventive measures. Parents and guardians can also give any additional information or special instructions in the space below this section.
This allows you to record any specific instructions that families and providers have agreed on, if your policies or local regulations require that level of detail.
Note that this section is optional, and parents should only fill it if they feel comfortable sharing these details with the staff, knowing that the daycare center will only access it if there’s an emergency.
Health insurance information (optional)
Another optional section. This one records details like:
- Insurance provider
- Policy number
- Contact number for the insurer
This section is not for every program, but it may prove to be quite useful. This information can speed up registration if a child is taken to a hospital or clinic for urgent care by the centre. Hospital staff can locate the child’s records more quickly and start treatment without any delay.
Parents/guardian acknowledgement and consent
At the end of the form, the parents/guardians will sign an acknowledgement that they’ve shared all the information in the form completely voluntarily and that they understand they had an option to withhold these details.
You have three checkboxes where, if checked, they consent to:
- Daycare staff using this information and giving basic first aid. This way, less time is wasted, and there’s no hesitation in using the details on the form to respond quickly when a child is hurt or unwell.
- Emergency transport to the nearest hospital, so staff can call an ambulance or arrange transport immediately.
- Emergency contact acting on their behalf, so designated person(s) can step in, coordinate care, or communicate with daycare until the parent/guardian is available themselves.
Who is This Form For
This childcare emergency form is designed for anyone who regularly cares for children and needs clear emergency details on file, including:
- Licensed daycare centers and childcare centers
- Preschools, pre-kindergarten, and early childhood programs
- Family child care homes / in-home daycare providers
- After-school and extended-day programs
- Short-term or part-time care (drop-in care, playgroups, “mother’s day out”)
- Camps and holiday programs for younger children
- Nannies and babysitters who want formal documentation
Besides contacting a child’s parents or guardians, it is important and often required by law that you document any incident that takes place on your premises. Having a structured incident report for daycares helps you not only to stay compliant but also to show your commitment to maintaining a safe environment for children.
What We Offer
- A completely customizable and editable form. You can tailor it to suit your daycare’s specific needs.
- Free download
- Available in Google Docs and MS Word formats
- Ready to print and be stored in PDF
Wrap Up
Childcare emergency forms give your team a clear, organized snapshot of each child’s key contacts and medical needs, so that when something unexpected happens, staff can focus on caring for the child instead of searching for information.
So reduce care and pickup stress and download our form today!
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