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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
    5 views2 pages

    Original Title

    2024 Medical_ Learning Info Form (1)

    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
    5 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
    of 2

    IF YOUR SON/DAUGHTER SUFFERS FROM ANY MEDICAL PROBLEMS PLEASE CONTACT

    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? SEVERITY MEDICATION REQUIRED?


    (low/medium/high) (Y/N)

    Asthma

    Diabetes

    Migraine

    Epilepsy

    Head Injury/ Concussion

    Allergy
    If the answer is yes, please provide
    details

    Requires Epipen?

    Any other conditions we should


    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. If 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. I give permission for the school to make such arrangements as are necessary for the treatment of my child
    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)


    ejejewbsrjshgeshjrbvesgygehwhgcfhbbvegrhewgwehnrebhjturrfehjerhehreh

    Parent/Cargiver’s Name Signature Date

    LEARNING AND BEHAVIOURAL INFORMATION

    Dyslexia Depression Regular Medication


    ADD/ADHD Anxiety Does this need to be
    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

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