Rivera Family Emergency Binder
This binder covers:
- Maria (Mom)
- Daniel (Dad)
- Sofia (age 9)
- Leo (age 4)
- Grandma Rosa (age 78)
- Pets: Biscuit (dog) and Mochi (cat)
How to use this binder
- Keep it somewhere easy to reach, like near the front door or in a hall closet.
- Tell everyone in the home where it is, including the kids and Grandma Rosa.
- Review and update it every 6 months.
- Store a copy with a trusted person, such as Aunt Carmen or a neighbor.
Binder kept at: ______________________________________
Copy kept with: ______________________________________
Last updated: ____________
<div style="page-break-after: always;"></div>Quick Emergency Numbers
EMERGENCY: CALL 911
Police, Fire, Ambulance
Poison Control: 1-800-222-1222
| Service | Phone |
|---|---|
| Police (non-emergency) | |
| Fire department (non-emergency) | |
| Nearest hospital | |
| Urgent care | |
Nearest hospital name and address:
Urgent care name and address:
When you call 911, say:
- What is happening.
- Our address: 42 Oak Lane, Springfield, IL
- Who needs help.
- Stay on the line until they tell you to hang up.
Last updated: ____________
<div style="page-break-after: always;"></div>Household Information
Address: 42 Oak Lane, Springfield, IL, USA
Nearest cross streets: ______________________________________
Home phone: ______________________________________
Household Members
| Name | Role/Age | Cell phone | Notes |
|---|---|---|---|
| Maria | Mom | Works from home | |
| Daniel | Dad | Works at Ace Hardware on 5th Street | |
| Sofia | Age 9 | Attends Lincoln Elementary | |
| Leo | Age 4 | Attends Little Sprouts Daycare | |
| Grandma Rosa | Grandma, 78 | Lives with us | |
Last updated: ____________
<div style="page-break-after: always;"></div>Emergency Contacts
OUT-OF-AREA CONTACT: Aunt Carmen Ortiz (Arizona) – (602) 555-3344
If we are separated, everyone calls or texts Aunt Carmen to check in.
Family & Out-of-Area Contact
| Name | Relationship | Phone | Notes |
|---|---|---|---|
| Aunt Carmen Ortiz | Maria's sister | (602) 555-3344 | Out-of-area contact (Arizona) |
| Uncle Ray | Daniel's brother | (555) 233-90 | Lives 20 min away. Number looks incomplete. Please check and correct. |
Neighbors & Friends
| Name | Relationship | Phone | Notes |
|---|---|---|---|
| Mr. James Lee | Next-door neighbor | (555) 410-7781 | Has spare key |
Medical
| Name | Relationship | Phone | Notes |
|---|---|---|---|
| Dr. Anita Patel | Kids' pediatrician | (555) 889-1200 | Sofia and Leo |
| Dr. Howard Kim | Grandma's cardiologist | (555) 889-4500 | Grandma Rosa |
| Happy Paws Animal Clinic | Vet | (555) 300-1122 | Biscuit |
School / Work / Childcare
| Name | Relationship | Phone | Notes |
|---|---|---|---|
| Lincoln Elementary front office | Sofia's school | (555) 700-4000 | |
| Little Sprouts Daycare | Leo's daycare | (555) 702-1188 | |
| Ace Hardware on 5th Street | Daniel's work | ||
Other
| Name | Relationship | Phone | Notes |
|---|---|---|---|
| Linda Brooks | State Farm agent | (555) 615-2020 | Insurance |
Last updated: ____________
<div style="page-break-after: always;"></div>Maria
| Name | Maria |
| Date of birth | |
| Allergies | Allergic to penicillin |
| Medications (location of list) | |
| Medical conditions/needs | |
| Doctor | |
| Blood type |
Other notes:
Last updated: ____________
<div style="page-break-after: always;"></div>Daniel
| Name | Daniel |
| Date of birth | |
| Allergies | |
| Medications (location of list) | |
| Medical conditions/needs | |
| Doctor | |
| Blood type |
Other notes:
Last updated: ____________
<div style="page-break-after: always;"></div>Sofia
| Name | Sofia |
| Date of birth | |
| Allergies | |
| Medications (location of list) | |
| Medical conditions/needs | |
| Doctor | Dr. Anita Patel (pediatrician), (555) 889-1200 |
| Blood type |
Other notes:
Last updated: ____________
<div style="page-break-after: always;"></div>Leo
| Name | Leo |
| Date of birth | |
| Allergies | Severe peanut allergy |
| Medications (location of list) | EpiPen in his backpack and one in the kitchen drawer |
| Medical conditions/needs | |
| Doctor | Dr. Anita Patel (pediatrician), (555) 889-1200 |
| Blood type |
Other notes:
Last updated: ____________
<div style="page-break-after: always;"></div>Grandma Rosa
| Name | Grandma Rosa |
| Date of birth | |
| Allergies | |
| Medications (location of list) | Takes heart medication (full list kept in her purse) |
| Medical conditions/needs | Uses a walker. Hard of hearing. |
| Doctor | Dr. Howard Kim (cardiologist) |