Diono R100 Emergency Information Sheet
Contents
1. ATTN EMT or Attending Caregiver This information is intended only EMERGENCY INFORMATION to provide additional specifics about the child This information should NOT dictate or influence procedures FOR CHILD Parent Please attach recent photo of child For additional copies of this form visit Diono com for any required medical attention Child Passenger Information Name Male Female Date of birth Eye color Hair color Known medical allergies i e penicillin latex etc Known medical conditions i e asthma etc Known medications Known food allergies i e peanuts strawberries etc Additional information Emergency Contact Information Name Tel 1 Tel 2 Name Tel 1 Tel 2 Pediatrician Tel
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