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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:*
*

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.

Learning For Life