[ ] Fall
[ ] Spring
[ ] Summer
Social Security Number _______-_____-________
I agree to follow the requirements below.
High School Principal/Counselor
The College of Marin provides student health services. I further understand that as a student of College of
Marin my daughter/son may avail themselves of the medical services providedby the Student Health Center
with my permission. Unless I provide written notice to the College of Marin Health Center Director, I hereby
grant College of Marin permission to provide the medical services to my minor daughter/son that she/he may
request. Parents also agree to be responsible for the student’s safe transportation to and from classes. The
signatures below represent approval of enrollment.
Concurrently enrolled students are restricted from physical education classes, and remedial classes
(classes numbered below 100).
College Credit Program (CCP Card)