Parent/Guardian Acknowledgement

Student Information

First

Middle

Last

Email Address

Date of Birth

U.S. Guardian Information

First

Middle

Last

Degree

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Guardian Email Address

Guardian Date of Birth

Guardian Phone

Relationship to Applicant

Checkbox 1

I understand that College of Marin strongly recommends that minor students live with family or approved guardians until age 18.

Checkbox 2

I understand that College of Marin is not legally responsible for the student's care or well-being outside of attending College of Marin.

Checkbox 3

I authorize my child's participation in College of Marin courses and understand they must comply with College policies.

Checkbox 4

I authorize College of Marin to obtain emergency medical treatment and allow Public Safety and Student Health Services to make decisions when necessary.

Parent/Guardian Name

Parent/Guardian Date of Birth

Relationship to Applicant

Electronic Signature

I certify that this information is true and complete.

Signature Date