Health Form to be completed by the caregiver. We will use your details provided below to ensure the validity of the sender.

Your Name (required)

Your Email (required)

Your Phone-number(required)

Student's Name (required)

Student's Form Class(required)

1. Does the student have any conditions or concerns that the school needs to be aware of?
    Yes No
   Details:

2. Does the student suffer from any allergy(ies)?
    Yes No
   If yes, please specify:

3. Does the student have to take any medication?
    Yes No
   If yes, please specify:
   It will be assumed that the student will be carrying all the appropriate medication and is competent in its administration.

4. Would the student be limited, in any way, in taking part in physical activities?
    Yes No
   If yes, please specify:

5. Is the student a competent swimmer?
    Yes No

6. I give permission for panadol to be given for pain or fever
    Yes No

Details of the student’s Medical Practitioner:

Doctor’s name:

Medical Practice name:

Contact number:

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