Medical Form - Sayers Croft - Year 4
Email address *
Child's name *
Your answer
Class *
Home telephone number *
Your answer
Mobile telephone number *
Your answer
Name and telephone number of alternative contact in an emergency: *
Your answer
Doctor’s name & telephone number: *
Your answer
Medical requirements/Notes i.e. Asthma, allergies etc.
Medical requirements/Notes i.e. Asthma, allergies etc. (please include details of medicines your child will need to take to Kingswood)
Your answer
Dietary Information: i.e. Vegetarian, any food allergies or dislikes:
Your answer
My child is in good health and I consider him/her fit to participate.In the event of an accident or illness I consent to any necessary medical treatment which might include the use of anaesthetics. *
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