Disaster and Emergency Preparedness: Guidance for ... - INEE Toolkit

Student-Family Reunification FormPART 1: KEEP THIS TOP PORTION AT REQUEST GATEPARENTS FILL IN THIS PARTStudent’s NameGradeSibling’s NameGrade✂ ——————————————————————————————————————————————PART 2: SEND THIS MIDDLE PORTION FROM REQUEST GATE TO ASSEMBLY AREA WITH RUN-NER. SEND IT TO RELEASE GATE WITH STUDENT. DateSTEP 1A – REQUEST GATE – PARENTS FILL IN THIS PARTStudent’s NameSibling’s NameTeacher(s)Parent/Guardian Name (Please Print)GradeGradeDisaster and Emergency Preparedness: Guidance for SchoolsSTEP 1B – REQUEST GATE – VERIFICATION – STAFF FILL IN THIS PARTName on Emergency Card: YES NO Proof of I.D.: YES NOAuthorized bySTEP 2 – ASSEMBLY AREA – STAFF FILL IN THIS PARTTeacher’s Signature:Note:(Principal or designee) Time✂ ——————————————————————————————————————————————PART 3: SEND THIS BOTTOM PORTION TO REUNION GATE WITH PARENT REUNION GATE:MATCH PARTS 2 and 3 OF THIS FORM, STAPLE AND FILESTEP 3A – RELEASE GATE – PARENTS FILL IN THIS PARTStudent’s NameSibling’s NameTeacher(s)Parent/Guardian Name (Please Print)Parent/Guardian SignatureDestination:STEP 3B – RELEASE GATE – STAFF FILL IN THIS PARTProof of I.D. YES NOAuthorized byGradeGradePhone Number(Principal or designee) Time released60