Minor Consent for Health Services


Long Beach City College Student Health Services provides first aid, emergency treatment, medical, and mental health services to students enrolled in Long Beach City College classes. If a student is under the age of 18, there is a legal requirement that Health Services as a Permission to Treat a Minor Form signed by a parent or legal guardian.

In order to ensure that the signature is valid, a copy of the parent/ legal guardian’s driver license or official ID is required. For emergency purposes, we are requesting two emergency contact numbers as well as a list of any allergies, serious medical conditions, and/or medications taken by the student. This information will be kept confidential in our files.

Please complete and sign the Permission to Treat a Minor Form, attach a copy of your ID or driver’s license, and have your student deliver to our office.

Permission to Treat a Minor Form