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Please fill in the form below to update the school about any medical conditions. If you prefer to do this offline please see our downloads page for a printable version of this form.

Note: Fields marked with a '*' are required.

Pupils Details
Pupils Name: *
Is there any additional medical information you wish to give us? *		Yes No If 'No' then please go to GP Section.
Please give details of any immunisations which have been given to your child since joining the school.
Please give details of any changes or additions to the information you gave when your child entered the school, eg the onset of asthma, eczema, hayfever, allergic reactions, hearing or sight problems, etc.
Please give details of any medical/surgical investigations or procedures which have taken place since completion of your original medical form.
Please give or reconfirm information about any medical treatment your child is receiving.
Please reconfirm whether there is any reason why your child should not take part in normal school sports and activities. *		Yes No
If 'Yes' please give details.
GP Details
Please confirm details of your family GP:
Name: *		Address: *
Telephone: *
Emergencies
The school keeps a small stock of medicines, creams, etc, all of which are non-prescription remedies. If you are happy for them to do so, authorised school staff will administer these as is necessary and appropriate, according to the stated dose. Please tick to acknowledge the statement below to give permission for this.
I give my permission for authorised school staff to administer non-prescription medicines as is thought appropriate and necessary.
In cases of illness or injury at school we will always try to make contact with parents or, if we are unable to do so, their nominated person. It is however possible that, should we be unable to contact parents, we may, in an emergency, need to make decisions on their behalf. Please check the box below to give us permission to do this.
I/we agree that in emergency where urgent medical/dental/surgical treatment is required and a parent or nominated person cannot be contacted, the school is empowered to give permission for any such treatment.
Name of parent or guardian
Address
Telephone no
Date: