Fill Out Your 4172 Form

What is the purpose of the 4172 form?

The 4172 form, also known as the Broward County Public Schools Student Emergency Contact Card, is used to gather essential information about students and their emergency contacts. This includes details about the student’s parents, authorized individuals for pickup, and any medical conditions or special needs. Schools require this information to ensure they can quickly reach a parent or guardian in case of an emergency.

How often should the 4172 form be updated?

The 4172 form must be updated every year. It is crucial to keep the information current, particularly regarding emergency contacts and any changes in the student's health or living situation. Parents and guardians are urged to notify the school office immediately if there are any significant changes to ensure the child's safety.

Who should be listed as emergency contacts on the form?

The form requires that both parents of the student, referred to as the registering and non-registering parents, be listed. Additionally, the parents should designate other individuals who are authorized to pick up the child from school. This includes anyone whom the parents trust and who is prepared to handle the child's unique needs if necessary.

Can one parent alter the contact information provided by the other parent?

No, one parent cannot delete or alter the other parent's provided information on the Emergency Contact Card. Each parent's information must remain intact unless a court order specifies otherwise. This ensures both parents' rights are respected, and it provides clear communication about authorized pickups.

What medical information needs to be provided on the form?

Parents should disclose any relevant medical conditions, medications, or allergies that the student has. This includes providing information about any special needs, such as requiring an inhaler or having a severe allergy that necessitates an EpiPen. This data is vital for school staff in case of a medical emergency.

How does the school handle the confidentiality of the information on the form?

The personal information provided on the 4172 form is kept confidential. It will be stored in a protected area and shared only on a need-to-know basis by school staff. This confidentiality helps to ensure that students' and families' privacy is respected while still allowing necessary information to be accessible during emergencies.

Filling out the 4172 form requires careful attention to detail. One common mistake is not updating the information each year. This form specifically states that it must be updated annually. Failure to do so can lead to communication issues during emergencies.

Another mistake is neglecting to provide accurate contact information. Parents often forget to include current phone numbers or addresses, which compromises the school's ability to reach them in an emergency. It is crucial to write down reliable contact methods, including home, work, and cell phone numbers.

Many individuals also struggle with proper identification of the registering and non-registering parents. The form requires both parents' names and should clearly distinguish between them. Misidentifying these roles can lead to misunderstandings regarding which parent has rights to pickup or contact the child.

Some families fail to consider special medical needs when listing authorized contacts. This omission can create a dangerous situation if a caregiver is unprepared to handle a child's specific health requirements. Those listing emergency contacts should ensure that these individuals are equipped to manage any medical needs.

Not providing complete and clear information about special needs is another frequent error. Many leave sections about medical conditions or medications blank or incomplete. This information is vital for the school to provide adequate care and address potential emergencies.

Finally, parents often overlook required signatures. The form mandates that designated individuals sign the card to indicate their recognition of responsibilities. Without these signatures, the form may not be valid, risking the wellbeing of the student in emergency situations.

When dealing with the Broward County Public Schools Student Emergency Contact Card (Form 4172), certain additional forms and documents are typically required to ensure the proper handling of a student's information and needs. These documents help in establishing clear communication and responsibilities among parents, guardians, and school authorities. Below is a list of common forms that accompany the 4172 form, each serving a specific purpose.

• Medication Authorization Form: This form is essential for students who require medication during school hours. It must be filled out by both a physician and the parent, detailing the medication's name, dosage, and administration schedule.
• Health Information Release Form: This document authorizes the school to share a child's medical information with emergency personnel and healthcare providers, ensuring all relevant details are accessible in case of an emergency.
• Emergency Contact Form: Separate from the 4172, this form allows parents to name additional emergency contacts who can be reached if primary contacts are unavailable during an emergency.
• Special Needs Documentation: If a student has special needs, this documentation outlines specific accommodations or services required, ensuring that school staff is informed and prepared.
• Transfer of Custody Form: In cases of custody arrangements, this form serves as legal verification of guardianship, establishing who is authorized to make decisions for the child.
• Transportation Release Form: To designate how a child will be picked up after school, this form outlines the designated persons responsible for the child’s transportation, particularly during emergencies.

Completing the 4172 form alongside these additional documents is critical for the safety and well-being of the student. It is imperative that parents and guardians keep this information current and provide all necessary forms promptly. Proper documentation not only facilitates emergencies but also ensures that the school has accurate records for each student.

• Student Health Record: Similar to the 4172 form, this document collects essential information about a student's medical history, emergency contacts, and health care needs. It ensures that school officials can take appropriate action in case of a medical emergency.

• Emergency Contact Information Form: This form serves a similar purpose by allowing parents to list emergency contacts and specify individuals authorized to pick up their child. It emphasizes clear communication between parents and the school during emergencies.

• School Enrollment Form: Like the 4172, this form gathers crucial personal details about the student, including parent information and emergency contacts. It is typically required when enrolling a child in school.

• Medical Authorization Form: This document is essential for sharing a student’s medical information with school staff. It outlines specific needs and permissions for healthcare treatment, paralleling the medical information section of the 4172.

• Parent Consent Form: This form seeks consent from parents for various school-related activities, mirroring the consent sections found in the 4172. It addresses the need for approval in emergency situations.

• Transportation Authorization Form: Similar to the 4172’s dismissal procedures, this document permits specific individuals to transport a student, ensuring that the child is released only to authorized persons.

• Field Trip Permission Slip: This form may resemble the 4172 in that it facilitates the collection of emergency contact information, collecting details required should an emergency occur during a school outing.

When filling out the 4172 form, it is important to approach the task with care and consideration. Here’s a helpful list of what to do and what to avoid.

• Do ensure all information is accurate. Provide precise details for each section, especially regarding emergency contacts and medical information.
• Do use clear handwriting. Legibility matters. Print clearly to ensure school staff can easily read the information.
• Do check the completion of both sides. Every area of the card must be filled in; overlook no section during the completion process.
• Do update the form annually. It’s essential to refresh the information yearly or when any changes occur in your child's situation.
• Do inform the school of any changes. Notify the school office immediately if any details need to be updated or corrected.

• Don't omit names of both parents. Both parents' names should be included unless a court order specifies otherwise.
• Don't alter the information provided by the other parent. Each parent’s input is valuable; modifications by one parent can lead to complications.
• Don't forget to signal medical needs. Mark any special medical requirements your child may have to ensure their safety.
• Don't use abbreviations. Avoid short forms or abbreviations when providing information; spell everything out clearly.
• Don't submit the form without reviewing. Take a moment to double-check all entries before handing it in.

Here are nine misconceptions about the 4172 form along with clarifications:

1. It’s a one-time form. Many believe they only need to fill out the form once. In reality, this form must be updated every year.
2. Only one parent is required to fill it out. Both parents should be listed on the emergency contact card unless a court order states otherwise.
3. Emergency contacts are optional. It’s essential to provide accurate emergency contacts. No student will be released to anyone not listed on the form.
4. Medications can be sent to school without documentation. All medications must be in their original prescription containers. A medication authorization form must also be completed.
5. Past records are sufficient. Each year, parents must declare that the information on the card is true and up to date.
6. The school can change information on the form. Only parents can modify the emergency contact information. The school cannot alter it without consent.
7. Non-registering parents cannot contribute to the form. The non-registering parent may designate additional persons whom the school can contact.
8. Providing information about siblings is unnecessary. This information helps the school understand family connections and support needs.
9. Sharing personal information is unsafe. The information provided is kept confidential and only used on a need-to-know basis within the school.

Filling out and using the 4172 form for Broward County Public Schools is an important process to ensure the safety and well-being of students. Here are key takeaways to consider:

• Annual Update Required: The 4172 form must be updated every year to ensure that all information is current and accurate.
• Complete Both Sides: It is essential to fill out both sides of the card thoroughly. Clear, printed ink is required for all entries.
• Parent Designation: Both the registering and non-registering parents must list individuals authorized to pick up their child, maintaining communication about any changes.
• No Alterations Allowed: Parents cannot delete or modify the other parent's entries on the form. This is to prevent confusion regarding authorized contacts.
• Medical Information Importance: Accurate medical information must be provided for any special needs or medication. This ensures that school staff are prepared in emergencies.
• Confidentiality Assurance: All personal data shared will remain confidential and used only on a need-to-know basis by school staff.