2024/2025 Bermuda Student Asthma Registry
To better assist students in Bermuda who have asthma to be healthy and safe at school, we ask that this form is completed for all children (ages 4-18) who have asthma.  

This registry is facilitated through a collaboration of The Bermuda Department of Education, The Bermuda Department of Health, The Bermuda Hospitals Board Asthma Education Centre and Open Airways (Bermuda Registered Charity #458).  

A SEPARATE FORM form should be completed for EVERY child with asthma in Bermuda.

Please only submit this form if student has asthma, otherwise exit now.
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Does your child have asthma? *
Child First Name *
Child Last Name  *
Child Birth DAY (between 1 & 31)  *
Child Birth MONTH *
Child Birth YEAR *
Gender *
Race
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Parent/Guardians Name *
Parent/Guardian EMAIL *
Parent/Guardian Primary Phone# *
Child's Doctor *
Child's School (pick from list) for 2024/2025 year *
If 'OTHER' - please provide name of school
Child's Year/Class Level *
(example: Primary 1, Foundation, IB2, Grade 3, Kindergarten, Middle 3, etc...)
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