Observation Form for University Students
Please fill out the form below. A representative will be in touch with you for further arrangements.

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Email Address *
Full Name *
Home Address *
Best Phone Number to Contact *
Name of University Attending *
Area of Study/Major
Special Skills or Talents *
Is there a specific classroom/teacher you'd like to observe? *
Date(s) of Availability for Observation (You may list more than one) *
Time(s) of Availability for Observation (You may list more than one) *
How many hours of observation do you need? *
Do you have any health problems which would limit your activity? *
Date of Last TB Test *
MM
/
DD
/
YYYY
Doctor's Name *
Please list all medication taken regularly (If not applicable, please write N/A) *
Do you give permission to be transported by ambulance, if necessary? *
Blood Type (Please write N/A if you don't know) *
In case of an emergency, please notify the following person(s) - Please list out Name(s), Relationship(s), and Telephone Number(s) *
By checking the box "I agree" below, I hereby waive Huntington Beach Union High School District and Ocean View High School from any responsibility for any circumstances arising as a result of incomplete or incorrect information. I hereby swear or affirm that I have never been convicted of a misdemeanor or felony offense under the penalty of perjury. *
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