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Student Medical Questionnaire

This form is to be completed and retained by the college for the duration your child attends the college. You must notify the college of any changes to medical conditions.

Student Details

Parent / Carer Details

GP Details

Pre-Existing Medical Conditions

 YesNo
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
 YesNo
Has the student received a vaccination against Tetanus during the last 10 years?
Is the student receiving medical or surgical treatment of any kind from the family doctor, hospital or an alternative therapist?

Parental / Carer Consent

I am happy for you to give my child Paracetamol and confirm that:*
*
Learning For Life