Emergency Child ID Record

A private record of important information to be given to authorities should the need arise.

Child’s Name: __________________________________

Keep Readily Available in a Safe Location
Document provided courtesy of

Assemblyman
David G. McDonough



Personal Information


Name (last)


(first)


(middle)

Attach
most
recent
photo
here.


Nickname



Date of Birth
Social Security Number


Mother’s Name



Phone
Social Security Number


Father’s Name



Phone
Social Security Number


Street



City
State
Zip


Fingerprints Most Police Departments will fingerprint your child for free.

right thumb right index right middle right ring right little
left thumb left index left middle left ring left little


Medical Information


Doctor’s Name
Phone

Birth Hospital
City, State
Phone

M  F
Sex

Blood Type

Race
Complexion

Eye Color
Hair Color

Height
Weight

Shoe Size
Clothing Size

Yes  No
Glasses?
Yes  No
Braces?

Chronic Illnesses

Medications

Allergies


DNA Sample

Dental Records
Have your child’s dentist complete this section.

Dentist’s Name

Phone

Dental Records


Child’s Favorite Things



Places







Foods







Pastimes







Other Identifying Activities, Mannerisms, etc.







It is my sincere hope that this document is never needed, but that completing it may offer some peace of mind to parents and guardians.

If you would like more copies, please do not hesitate to contact my offices:

404 Bedford Avenue • Bellmore, NY 11710 • (516) 409-2070 or
533 Legislative Office Building • Albany, NY 12248 • (518) 455-4633
e-mail: mcdonoughd1@assembly.state.ny.us

— Assemblyman David G. McDonough

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