New starters - Seniors

Fields marked with * are required

Child's current year group*

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Child's Surname:*

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Child's Forenames:*

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Date of Birth:*

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Year group & Date/Term of Entry (eg Year 7 September 2024)*

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Name of GP:*

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Name of Practice:*

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Are all immunisations up-to-date?*

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Does your child have any allergies including food, medication?*

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Allergy, Symptoms and Action Taken/Treatment:

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Does your child suffer from any pre-existing medical conditions or disability?*

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Pre-existing medical conditions:

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Does your child take any regular prescribed medications, inhalers, anti-histamines or EPIPEN?*

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Prescibed medications, inhalers, anti-histamines or EPIPEN:

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Do you consider your child fit to take part in normal games or activities?*

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Reasons

Does your child require a special diet?*

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Diet details:

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Parent Full Name:*

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Parent Consent

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By checking the Parental Consent option the parent has consented for the School Nurse to:

- Administer 'over the counter' medication as required for minor illness, aches or pains e.g. headache, cold symptoms etc.
- Carry out routine health checks of height and weight.
- Administer first aid treatment of minor injuries.
- Transport my child to hospital in case of an emergency.
- Act in loco parentis if emergency medical treatment is required as determined by the medical authorities (please note that every effort will be made to contact you if your child requires hospital treatment).