Student Medical Questionnaire

Data Protection Act (GDPR) 2018 - The information that you provide on our forms will be held on the computerised database maintained by the college as the data controller. Your data will be used in accordance with the principles set out in the GDPR 2018, which protects the right to privacy of individuals whose personal details are held by the data controller. The Henry Cort Community College will only make details available within the Local Authority; to Hampshire County Council schools and their governance bodies; the Department of Education or any other bodies involved with the care of children in this college. This information is gathered in order to enable the provision of education and other associated functions. In addition, the college may be required by law to collect, use and share certain information. In accordance with Hampshire County Council’s retention schedule we will keep students’ data including religion, and medical information until the child reaches age 22, unless there is a child protection issue, in which case the records will be kept until age 25.

If there are any changes to your child’s medical condition(s) it is the parent’s responsibility to notify us.

Child's Surname* Child's Forename* Date of Birth* Tutor Group* Current address* Name of Parent / Carer* Home telephone number* Mobile number* Work number Email Address GP Name and Address* GP telephone number* Child's NHS Number (if known) Has your child had any of the following conditions?*

	Yes	No
Asthma or Bronchitis
Heart Condition
Fits, Fainting or Blackouts
Severe Headaches
Diabetes
Allergies to any medication
Any other allergies
Travel Sickness
Other illness or disability

If the answer to any of the above is YES, please give details below: Please give details of any other conditions that would limit the activities in which your child could participate:* Additional information*

	Yes	No
Has your child received a vaccination against Tetanus during the last 10 years?
Is your child receiving medical or surgical treatment of any kind from the family doctor, hospital or an alternative therapist?
Has your child been given specific advice to follow in emergencies?

If the answer to any of the above is YES, please give details below:*

Parental / Carer Consent

I am happy for you to give my child Paracetamol and confirm that:*They have had paracetamol before and did not have an allergic reaction to it.They are not currently taking any medicines that would react with paracetamol.I will inform the college if they start any medicines that would interact with paracetamol.

*I acknowledge that the first aid staff in college are not medically trained.In the event of any illness or medical treatment occurring after the return of this form, I undertake to inform the college.

Name of Parent / Carer completing form* Date*

Aspire

Achievement•Support•Perseverance•Individuality•Respect•Excellence

Cookie Policy

This site uses cookies to store information on your computer. Click here for more information