Student Emergency Forms

 
Page 1 of 1
 
 Steel Center Student Emergency Form 
Please complete the Emergency Form below with your students information and submit it.

 

 
1.
*
 
   
2.
*
 
   
3.
*
 
   
4.
*
 
*


   
5.
*
  Select Date
mm/dd/yyyy
   
6.
*
ie. Baldwin, Thomas Jefferson, Mon Valley etc.
 
   
7.
*
 
*





    
   
8.
*
 
   
9.
*
 
   
10.
*
 
   
11.
*
 
   
12.
*
 
    
Parent/Guardian Phone   
   
13.
*
 
   
  In case of emergency, accident or illness to the student named above, the school is authorized to provided transportation to Jefferson Hospital.
   
14.
*
 

 

 

 

 

 
   
15.
*
 

 

 

 

 

 
   
16.
*
 

 

 

 

 

 
   
17.
*
 
   
18.
*
 
   
19.
 
    
Name of Medication   
Dosage   
Medical Reason   
   
20.
 
   
21.
 
   
22.
 
   
23.
 
   
24.
*
 
   
  The Parent/Guardian Request for Medication Administration Form must be on file with the school before your student takes any prescription or non-prescription medicines at Steel Center. This form may be obtained in the Main Office by the student or by telephoning 412-469-3200, extension 2529. Steel Center follows all relevant federal and state guidelines concerning student confidentiality as set forth under FERPA and HIPPA and all other relevant state and federal laws. The student emergency and medical information contained on this card will be shared with appropriate medical, educational, and legal agencies when a situation arises that warrants such disclosure.
   
 
 
 
 Done