The ______________ Family 

STEP Logo
Emergency Information Sheet 

 

Out-of-State Contact Name: ________________________ Telephone Number:_________________ 
Email:_________________ 

Family Member Profiles: 

 

 

Name: _________ Date of Birth:________ 

 

Medical Information_________________ 


_________________________________ 


 

Name: _________ Date of Birth:________ 

 

Medical Information_________________ 


_________________________________ 


 

 

 

 

 

 

 

 

 

 

Name: _________ Date of Birth:________ 

 

Medical Information_________________ 


_________________________________ 


Name: _________ Date of Birth:________ 

 

Medical Information_________________ 


_________________________________ 


 

 

 

 

 

 

Where Family Members May Be and Evacuation Meeting Places: 

 

Home Address: ___________________________ Work 1 Address: ________________________ 

Phone Number: ___________________________ Phone Number: ________________________ 

Meeting Place: ___________________________ Meeting Place: __________________________ 

 

Work 2 Address: ___________________________ School 1 Address: ______________________ 

Phone Number: ___________________________ Phone Number: ________________________ 

Meeting Place: ____________________________ Meeting Place: ________________________ 

 

School 2 Address: _________________________ Other Address: _______________________ 

Phone Number: ___________________________ Phone Number: ________________________ 

Meeting Place: ____________________________ Meeting Place: ____________________ 

 

Important Phone Numbers: 

 

Local Police Department: __________________ Local Fire Department:_________________ 

Poison Control: ____________________ (Enter Other) _______________:______________ 

Doctor ________’s Office: ________________ Doctor __________’s Office: ________________ 

Veterinarian’s Office: _____________________ _______________: _____________________