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Authorization for Request or Release of Medical - CSU, Chico 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your last name and first name in the designated fields. Ensure accuracy as this information is crucial for identification.
- Indicate whether you are 18 or over by selecting 'Yes' or 'No'. This helps determine consent capabilities.
- Fill in your birth month and day, student ID, cell number, and email address. This information is essential for contact purposes.
- Provide details about your faculty/coordinator and the date of the event. If applicable, include your course number.
- Complete the emergency contact section by listing two contacts with their names, relationships, addresses, phone numbers, and languages spoken.
- Answer the allergy questions clearly. If you have allergies, provide explanations in the space provided.
- If you have dietary restrictions, please specify them in the designated area.
- Finally, sign and date the form at the bottom to authorize the release of your medical information if necessary.
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