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    2024 Medical - Learning Info Form

    Uploaded by

    jeffwang291112

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    2024 Medical - Learning Info Form

    Uploaded by

    jeffwang291112
    4 views2 pages

    Original Title

    2024 Medical_ Learning Info Form

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views2 pages

    2024 Medical - Learning Info Form

    Uploaded by

    jeffwang291112

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    ‭ F‬ ‭YOUR‬ ‭SON/DAUGHTER‬ ‭SUFFERS‬ ‭FROM‬ ‭ANY‬‭MEDICAL‬‭PROBLEMS‬‭PLEASE‬‭CONTACT‬

    I
    ‭THE SCHOOL TO DISCUSS APPROPRIATE CARE AND FORMULATE AN ACTION PLAN.‬
    ‭Has your child had the following vaccinations? If yes, please tick all the appropriate boxes.‬

    ‭6 Week Immunisation‬ ‭4 Year Immunisation‬


    ‭3 Month Immunisation‬ ‭11 Year Immunisation‬
    ‭5 Month Immunisation‬ ‭12 Year Immunisation‬
    ‭15 Month Immunisation‬

    ‭NAME OF GP‬ ‭PHONE NUMBER‬

    ‭HAS/DOES THE STUDENT SUFFER FROM?‬ ‭ EVERITY‬


    S ‭ EDICATION REQUIRED?‬
    M
    ‭(low/medium/high)‬ ‭(Y/N)‬

    ‭Asthma‬

    ‭Diabetes‬

    ‭Migraine‬

    ‭Epilepsy‬

    ‭Head Injury/ Concussion‬

    ‭Allergy‬
    I‭ f the answer is yes, please provide‬
    ‭details‬

    ‭Requires Epipen?‬

    ‭ ny other conditions we should‬


    A
    ‭know about?‬
    ‭If the answer is yes, provide more‬
    ‭details e.g. dietary, physical or‬
    ‭health conditions‬

    I‭ give permission for the school to‬


    ‭administer 1 Panadol tablet or the‬
    ‭liquid equivalent if necessary‬

    I‭ give permission for the school to‬


    ‭administer 1 antihistamine tablet‬
    ‭or the liquid equivalent if‬
    ‭necessary‬

    ‭1‬
    ‭IN CASE OF ILLNESS, ACCIDENT OR EMERGENCY:‬

    ‭1.‬ I‭ f‬ ‭the‬ ‭school‬ ‭is‬ ‭unable‬ ‭to‬ ‭contact‬ ‭me,‬ ‭or‬ ‭if‬ ‭the‬ ‭accident‬ ‭is‬ ‭serious,‬ ‭I‬ ‭give‬ ‭permission‬ ‭for‬ ‭the‬ ‭school‬ ‭or‬
    ‭delegate to take my child to Accident and Emergency or a doctor.‬
    ‭2.‬ ‭I‬‭give‬‭permission‬‭for‬‭the‬‭school‬‭to‬‭make‬‭such‬‭arrangements‬‭as‬‭are‬‭necessary‬‭for‬‭the‬‭treatment‬‭of‬‭my‬‭child‬
    ‭in an emergency and agree to meet any costs incurred.‬
    ‭3.‬ ‭I‬ ‭accept‬ ‭that‬ ‭while‬ ‭my‬ ‭child‬ ‭is‬ ‭a‬ ‭student‬ ‭at‬ ‭Remuera‬ ‭Intermediate,‬ ‭it‬ ‭is‬ ‭my‬ ‭responsibility‬ ‭to‬ ‭inform‬ ‭and‬
    ‭update the school of any important medical conditions they may have.‬

    ‭(Full Name)‬ ‭(Sign here)‬ ‭(dd/mm/yyyy)‬

    ‭Parent/Cargiver’s Name‬ ‭Signature‬ ‭Date‬

    ‭LEARNING AND BEHAVIOURAL INFORMATION‬

    ‭Dyslexia‬ ‭Depression‬ ‭Regular Medication‬


    ‭ DD/ADHD‬
    A ‭ nxiety‬
    A ‭ oes this need to be‬
    D
    ‭Autism/Aspergers‬ ‭Other learning / behavioural‬ ‭administered at the‬
    ‭needs.‬ ‭school?‬
    ‭(Please provide details below)‬ ‭(If any of the above is‬
    ‭ticked, please provide‬
    ‭details below.)‬

    ‭Details‬

    ‭PLEASE ATTACH ANY MEDICAL REPORTS/ ASSESSMENT RELATED TO THE ABOVE.‬

    ‭CODE OF CONDUCT‬
    I‭ accept that my child, while a student at Remuera Intermediate will comply with and respect the‬
    ‭expectations, uniform requirements and standards set by the school and the Board of Trustees.‬

    ‭(Full Name)‬ ‭(Sign here)‬ ‭(dd/mm/yyyy)‬

    ‭Parent/Cargiver’s Name‬ ‭Signature Date‬

    ‭2‬

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