2024-2025 Berkeley County Schools Annual Emergency Information Update

Emergency Contacts

IMPORTANT: Please list individuals OTHER THAN those listed as Parent/Caregivers

Emergency Contact 1
Name - Emergency Contact 1*

First NameLast Name
Relationship - Emergency Contact 1*
If "other," please list relationship below:*
Can this person pickup the student?*

YesNo
Best Contact Phone Number - Emergency Contact 1*
Please enter a valid phone number.
Cell Phone (if applicable) - Emergency Contact 1
Please enter a valid phone number.
Home Phone (if applicable) - Emergency Contact 1
Please enter a valid phone number.
Email Address- Emergency Contact 1
example@example.com

Emergency Contact 2
Name - Emergency Contact 2

First NameLast Name
Relationship - Emergency Contact 2
If "other," please list relationship below:
Can this person pickup the student?

YesNo
Best Contact Phone Number - Emergency Contact 2
Please enter a valid phone number.
Cell Phone (if applicable) - Emergency Contact 2
Please enter a valid phone number.
Home Phone (if applicable) - Emergency Contact 2
Please enter a valid phone number.
Email Address- Emergency Contact 2
example@example.com

Emergency Contact 3
Name - Emergency Contact 3

First NameLast Name
Relationship - Emergency Contact 3
If "other," please list relationship below:
Can this person pickup the student?

YesNo
Best Contact Phone Number - Emergency Contact 3
Please enter a valid phone number.
Cell Phone (if applicable) - Emergency Contact 3
Please enter a valid phone number.
Home Phone (if applicable) - Emergency Contact 3
Please enter a valid phone number.
Email Address- Emergency Contact 3
example@example.com

Emergency Contact 4
Name - Emergency Contact 4

First NameLast Name
Relationship - Emergency Contact 4
If "other," please list relationship below:
Can this person pickup the student?

YesNo
Best Contact Phone Number - Emergency Contact 4
Please enter a valid phone number.
Cell Phone (if applicable) - Emergency Contact 4
Please enter a valid phone number.
Home Phone (if applicable) - Emergency Contact 4
Please enter a valid phone number.
Email Address- Emergency Contact 4
example@example.com

Medical Information
Primary Care Physician

First NameLast Name
PCP Work Phone
Please enter a valid phone number.
Dentist

First NameLast Name
Dentist Work Phone
Please enter a valid phone number.
Does the student have *physician-verified* allergies, take regularly prescribed medications, or have a special dietary plan?

YesNo
List student allergies*
Are these allergies life-threatening, require an Epi-Pen, or cause anaphylaxis?*

YesNoN/A

Medication my student receives on a regular basis (if student takes medication during school hours, please click on link to BCS Administration of Medication form):*

	Medication Name	Dosage	Time of Day
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5

Please download and fill out the BCS Administration of Medication Form for each medication. You will be asked to upload this at the end of the form.
Please download and complete the Special Diets Form. You will be asked to upload this at the end of the form. The form must be verified and signed by a medical professional.

Special Education
Does your student have a 504 Plan?*

YesNo
Does your student have an IEP?*

YesNo
Please describe any behavioral, special needs, or mental health conditions that your child may have:
You will be asked to upload any documentation at the end of this form.

Upload Documents
If you have no applicable documents to upload, please select "Next."
Upload Custody Papers (if applicable)

Cancelof
Upload 504 Plan (if applicable)

Cancelof
Upload I.EP. (if applicable)

Cancelof
Upload BCS Administration of Medication Form

Cancelof
Upload Medical Plan for School Food Service (Special Diet)

Cancelof

Ready to Submit?
Certification Agreement - By Submitting this Form I Acknowledge the Following

I certify that I am 18 years of age or older, or an emancipated minor, and I am legally authorized to register my child for programs and activities at Berkeley County Schools and its affiliated organizations.

I have reviewed the information provided and ensure this information is up-to-date and accurate.
Type Full Name as Electronic Signature*
Should be Empty:

	First & Last Name	Birthdate (MM-DD-YYYY)	Grade	Gender
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6

2024-2025 Berkeley County Schools Annual Emergency Information Update

Basic Student Information

Contact Information

Household Information

Home Language Survey

Military Family Information

Emergency Contacts

Medical Information

Special Education

Permissions

Agreements

Ready to Submit?