*Please keep in mind that a parent or an additional person must be available for contact 24 hrs/day
Additional Emergency Contact (NOT parent/guardian listed above):
Please include a copy of both sides of every insurance card for your child, including hospitalization and prescription cards for private insurance, Medicaid and/or Children's Special Health Care Services.
If your child has NOT been fully immunized, you must sign a form provided by HFM.
Immunization Waiver/Exemption Form
Questions? Please contact Tim Wicks at 734.544.0015 ext. 7 or at firstname.lastname@example.org.