Medical Form

Has your child had chicken pox?

Heart condition *

Nervous disorder *

Allergies (penicillin, sulfa drugs, serum, foods) *

Blood disorders *

Special diet *

Childhood diseases (mumps, chicken pox) *

Skin problems / rashes *

Sickle cell anaemia *

Surgery of any type *

Asthma / respiratory problems *

Past admission to hospital *

Prescribed medication for other concerns *

Is there a condition in the family the school should be aware of? *

Is there any reason your child should not take part in physical activities? *