Find us Open days & events Register your interest

Personal Medical Information PREP (New starter)

Please complete the form below to register your child’s personal medical information with the School Nurse. If your child has a medical condition requiring a health care plan in school, the School Nurse will contact you. All the information you give will be treated in confidence, except where it is in the best interest of the child that a relevant member of staff should know about a specific illness (e.g. asthma or allergies).

Fields marked with an * are required

Personal Medical Information PREP (New starter)

Child's current year group *(Required)

Child's Surname(Required)

Child's Forname(s)(Required)

Date of birth *(Required)

Year Group and Date/Term of Entry (Example: Year 6 September 2025) *(Required)

Name of GP *(Required)

Name of Practice *(Required)

Are all immunisations up-to-date *(Required)

Please state your child's diet *(Required)

Please let us know of any dietary requirements for yourself and your child:(Required)

Does your child have any allergies including food or medication? *(Required)

If your child has an allergy, please outline the allergy, symptoms and action taken/treatment required below. If your child does not have an allergy, please write 'none'.

Please state the allergy, symptoms and action taken/treatment(Required)

If your child has an allergy, please outline the allergy, symptoms and action taken/treatment required below. If your child does not have an allergy, please write 'none'.

Does your child suffer from any pre-existing medical conditions or disability? e.g. asthma, diabetes, epilepsy, migraine, eczema, hay fever, learning difficulties, mental health issues, sight/hearing? *(Required)

Pre-existing medical conditions *

If your child has any pre-existing medical conditions, please outline the condition, and details and treatment below. If your child does not have a pre-existing medical condition, please write 'none'.

If your child suffers from a chronic lung condition/disease or cystic fibrosis, it is very important that you email nurse@westholmeschool.com to inform us of this immediately. This will ensure that we are able to meet our commitment to keeping all our pupils safe in school.

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

If yes, please ensure that your child has a supply of them when they start at school.

Prescribed medications, inhalers, anti-histamines or EPIPEN *(Required)

If your child has any regular prescribed medications, inhalers, anti-histamines or EPIPEN please outline the 'Medication taken', 'Doses and number of times a day', and the 'Reason for taking' below. If your child does not take any regularly prescribed medicines, please write 'none.

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

(If no, please provide details below)

Please outline the reasons, if you answered 'No' to the above question. *(Required)

If you answered 'Yes', please write N/A.

Does your child require a special diet? *(Required)

If yes, please provide details below

Diet details *(Required)

If your child has no dietary requirements, please write 'none'.

Parent Full Name *(Required)

First Last