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Signal Mountain Presbyterian Church

an Evangelical Presbyterian Church near Chattanooga, Tennessee

Emergency Contact Card

Parents, the safety of your children while they are in our care is incredibly important to us. We ask that all families have current emergency contact information on file with us.

To avoid any confusion, please fill a separate form out for each child.

  • Click the + sign to add more rows.
    NameAge 
  • Please list two people who can serve as an emergency contact if a parent is not available. Click the + sign to add more rows.
    NamePhone 
  • PediatricianPhone NumberPreferred Hospital 
  • Section Break

  • If your student/child uses an EPI Pen, please send in a labeled bag with your student/child, each time they come.
  • Section Break

  • I, the parent/guardian of child being registered, authorize the adult leaders of Signal Mountain Presbyterian Church, to act as my agent to consent to emergency treatment. I understand that every attempt will be made to contact the parent/guardian in the event of any emergency. I therefore assume all responsibility for decisions so made, and the emergency care or treatment secured for my child. This includes Signal Pres to administer one (1) dose of no dye liquid Benadryl in case of allergy reaction.
  • This field is for validation purposes and should be left unchanged.

Contact

Signal Mountain Presbyterian Church
612 James Boulevard
Signal Mountain, TN 37377

p: (423) 886-2190
f: (423) 886-3977
office hours: 8:30 AM-5:00 PM
Contact Us

Worship with Us

Sunday Worship: 9 AM, 11 AM & 4 PM
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Twitter

  • Special announcement from Scott & the elders // Also, check your email for a letter that was emailed. Remember, it… https://t.co/UVVOCEsL8m March 14, 2020 4:39 PM
  • @signalpres is on twitter.

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