www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

• Identification and Emergency Information (LIC 700) –                                                     

• Child’s Pre-Admission Health History – Parent’s Report (LIC 702)                                               

• Consent for Emergency Medical Treatment (LIC 627)                                                      

• Consent/Verification for Nebulizer Care (LIC 9166) – if needed                                  

• California School Immunization Record (copy on blue card) (PM 286)                      

(for our files, please keep updated)/request for exemption

• Notification of Parents’ Rights (LIC 995A)                                                                                              

(Please, keep the top portion of this form, and return the bottom portion)