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Child Care Center Emergency Identification Tags Request Form

If you require additional tags, please complete the form below and click submit. Your request form will be forwarded to the Office of Emergency Medical Services for Children for processing. Should you have any questions, please feel free to call the office at (609) 633-7777.

To guarantee prompt delivery please complete this form in its entirety including any special comments.
Agency Name:
Person Requesting Tags:

Mailing Address:
(No deliveries are made to P.O. Boxs)
Street:
City:
State:   Zip Code:
Phone Number: - -
Email Address:
Number of each Color Tag Requested (red, yellow, green):   each
Number of Packets of Emergency Tags Requested:   each
Message/Comments:
 
  

Department of Health and Senior Services
P. O. Box 360, Trenton, NJ 08625-0360
Phone: (609) 292-7837
Toll-free in NJ: 1-800-367-6543
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Last Modified: Monday, 31-Dec-07 15:20:32