Medical Form MEDICAL INFORMATION FORM PARENTS'S DETAILSFather's name(Required) Father's mobile number(Required) Father's email(Required) Mother's name(Required) Mother's mobile number(Required)Mother's email(Required) MEDICAL CONDITIONSFirst Name(Required) Middle Name(Required) Last Name(Required) Date of Birth(Required) MM slash DD slash YYYY Place of Birth Gender(Required)MaleFemaleMEDICAL CONDITIONSDoes your child suffer from Diabetes Nut Allergies Other Allergies Epilepsy Non-Epileptic Convulsions Eyesight Difficulties Hearing Difficulties Take Regular Medication Eczema Undergone Major Surgery Any Serious Illness Asthma - Requires Medication Mild Asthma Has you child ever had any of the following diseases German Measles (Rubella) Measles Mumps Chicken Pox Meningitis Hepatitis Glandular Fever Whooping Cough Flu If you answered "Yes" to any of the above medical conditions, please provide further details. The School cannot accept responsibility for the consequences of withheld relevant information that would otherwise ensure your child's welfare.Has your child been inoculated against Polio / Tetanus / Diphtheria B.C.G. (TB) Measles, Mumps, Rubella (MMR) Polio Meningitis, A, C, W135, Y Tetanus AUTHORISATIONPlease select one of the following options:(Required) hereby authorise the school to administer the above listed medications at the discretion of the Medical staff. I hereby do NOT authorise the school to administer the above listed medications at the discretion of the Medical staff. In case of an emergency and we need to transfer the child to hospital, we kindly ask your approval on any of the following:(Required) Transfer the child and call you. Call you and wait for the ambulance. Call you and wait for you to arrive. Parent/Guardian name: CAPTCHA
