Medical Information

First Name

Last Name

Student ID

1. Please attach updated vaccination records (PDF document) .

4. Dietary requirements:

5. Please indicate whether your child has been given CALPOL or PARACETAMOL syrup to reduce fever & pain:

YesNo

6. In the event of a medical emergency we would normally take children to The Surgery clinic, Naguru.

7. In the event that a child becomes ill during the school day, we would prefer to call the parent or guardian to come and collect the child.
If this is not possible, we shall look after them at school. Please also provide names and telephone numbers of additional contact persons
apart from the parents.

Tel No:

Name of Contact Person:

Relationship:

Please have this section below approved by your Doctor!

Is this child fit to attend school and take part in normal school and sporting activities?

YesNo

Additional remarks:

Name of Doctor

Doctor's Mobile No:

Clinic Name