Online Medical Form
Please read this form carefully and complete it to the best of your ability.
First Name *
Your answer
Surname *
Your answer
Gender *
Date of Birth *
Your answer
Year Group *
Form Group *
Does your son/daughter suffer from any condition requiring medical treatment, including medication? If YES, please give details. *
Your answer
To the best of your knowledge, has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be or may become contagious or infectious? If YES, please give details. *
Your answer
I agree to my son/daughter receiving emergency treatment including anaesthetic as considered necessary by the medical authorities present. I authorise the supervisor/teacher to sign on my behalf any written form of consent required. *
Required
Please outline any special dietary requirements for your child *
Your answer
I undertake to inform the school as soon as possible of any change in the medical circumstances of my son/daughter. *
Required
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