Emergency & Disaster Release FORM1 A.doc. PM 171a Bilingual - ccusd 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the registration information, including the school year and any changes to your address or phone number from the prior year.
3. Enter the student's full name, nickname, gender, grade, birth date, and birthplace in the designated fields.
4. Provide the student's home address and contact numbers. Specify who the student is living with by selecting from the options provided.
5. List emergency contacts by entering their names, addresses, relationships to the student, and phone numbers. Ensure you include an out-of-state contact for emergencies.
6. Detail any health information regarding medications or allergies that may affect your child during school hours.
7. Finally, review all entered information for accuracy and sign at the bottom of the form to authorize emergency treatment if necessary.

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