Medical Conditions
If your child has a known medical condition please complete and submit this form. By submitting this form you are informing St James' Primary School of your child's medical condition and are agreeing that the information provided is up to date and accurate on the date submitted.
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Email *
Child Name *
Child's date of birth ../../.... *
Child's address *
Medical diagnosis or condition *
CONTACT No.1 Contact Information
Contact 1 - Full Name *
Contact 1 - Home/Daytime telephone number *
Contact 1 - Mobile number *
Contact 1 - Work Number
Contact 1 - Email *
Contact 1 - Relationship to child *
Contact 2 - Full Name
Contact 2 - Home/Daytime telephone number
Contact 2 - Mobile number
Contact 2 - Work Number
Contact 2 - Email
Contact 2 - Relationship to child
Name of clinic/hospital contact and telephone number
GP name and telephone number *
Fully describe your child's medical needs and give details of child's symptoms, triggers, signs, treatments, facilities, equipment or devices, environmental issues or any other medical needs *
Describe what constitutes an emergency, and the action to take if this occurs *
Name of medication, dose and method of administration. Please state even if administration is not during school hours. *
Daily care requirements different to other children
Other information
Parent Name *
Date ../../.... *
A copy of your responses will be emailed to the address you provided.
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