Medical form

Emergency contact details

Does the emergency contact speak English?*
YesNo

Health declaration

If your child has a severe condition which could be life threatening e.g. a serious nut allergy you will not be able to complete the form and should contact the office directly for advice.

I confirm that he/she does not have any life threatening conditions.* Yes

Does he/she have a special diet? e.g. vegetarian, vegan, lactose intolerance* YesNo

Has he/she been affected by or requires treatment for any of the following? Allergies Hay fever Asthma Migraine/headaches Sleep walking, bed wetting, poor bladder or bowel control Eczema/skin condition Eating disorders (in last two years) Psychological problems Endocrine disorder (eg Diabetes, Thyroid etc) Convulsion/epilepsy Ear, nose or throat problems Hearing problems Heart condition

Is there any reason why he/she should not take part in all the normal school sports and activities?* YesNo

Can he/she swim 50 metres?* YesNo

Is your child's Tetanus injection up to date?* YesNo

Do you give us permission to give your son/daughter paracetamol if needed? * YesNo

Do you give us permission to carry out basic First Aid on your child if needed? * YesNo

I agree that the medical information given is correct to the best of my knowledge (6.1.).*
Yes