Has your son / daughter been immunised against any of the following conditions? Please state date given where appropriate.
***PLEASE NOTE THAT INFORMATION REQUIRED THAT HAS NOT BEEN PROVIDED ON THIS FORM, MUST BE PROVIDED BEFORE YOUR CHILD STARTS IN SEPTEMBER. FOR OUR RECORDS, PLEASE ENSURE THE SCHOOL NURSE RECEIVES THIS***
* Please note for date inserts: to skip back dates by year, please click on month/year displayed for more options
Please give as much information as possible. This helps us give your child the best possible care.(Include things such as hospital visits, significant injuries, eating problems, any form of counselling / mental health treatment, significant family bereavements, bed wetting or other continence problems.)
Please note: If you have specified that your child needs an adrenaline pen or an inhaler they must have two in date pens or an in date inhaler in school at all times. In line with school policy for trips and excursions they must bring two pens or an inhaler with them, otherwise they will not be allowed to take part in the trip.
I give permission to the Headmaster or designated representative to give consent to any dental, medical or surgical treatment, if the school is unable to contact parents / guardians.
I give permission for my child to receive medication from a qualified nurse or designated member of staff according to the School's Medical Needs Policy for the administration of drugs. This includes over the counter non-prescription medication, including the following: Paracetamol, Ibuprofen or antihistamines.
I undertake to keep the School Nurse and / or the Health Centre, fully informed of any medical conditions that may arise in the future.
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