Current Pupil Annual Update Medical Form Parent/Guardian Name(Required) First Name Last Name Parent/Guardian Email address(Required) Enter Email Confirm Email Child's Name(Required) First Name Last Name Child's Town and Country of Birth Gender(Required) Male Female Child's Year Group(Required)Year 7 (Remove)Year 8 (Inters)Year 9 (Lower Transits)Year 10 (Upper Transits)Year 11 (Shell)Year 12 (Study I)Year 13 (Study II)Date today(Required) MM slash DD slash YYYY Child's blood group(Required) Child's NHS number(Required) Please tick if your child: has suffered from any significant illness or had any operations is currently receiving treatment or suffering from any condition If you have ticked either of the boxes above, please provide details: Does your child have any known allergies?(Required)YesNoIf yes, what kind of allergies?(Required) Please give information on how this allergy is usually treated:(Required) Epi-pen Inhaler Cetrizine If you have ticked 'Cetirizine' above, you will need to bring your own anti-histamine supply, which has to be declared to Miss Mialkowski (ashleigh.mialkowski@wychwoodschool.org) in writing via email with instructions in English and labelled with your name Current doctor's name and surgery(Required)Current doctor's telephone number(Required)Has your child had an annual Flu dose(Required) Yes No Date of Flu dose(Required) MM slash DD slash YYYY Please give any details and dates of any other vaccinations your child has had in the last year:(Required)I give my permission for a qualified First Aider to administer first aid as necessary.(Required) Yes No In the case of emergency, I consent to medical, dental and optical treatment being given. (NB Parents are always contacted wherever possible.)(Required) Yes No For day pupils, please tick the boxes if you permit us to administer any of the following as required:(Required) Paracetamol Calpol Six Plus (paracetamol suspension) Throat sweets (Strepsils) Antiseptic cream (Savlon) Burns treatment Bites and sting cream (Eurax) Hypoallergenic plasters For boarders, please tick the boxes if you permit us to administer any of the following as required:(Required) Paracetamol Calpol Six Plus (paracetamol suspension) Ibuprofen (12+) Ibuprofen gel Nurofen for Children (ibuprofen suspension) Throat sweets (Strepsils) Antiseptic cream (Savlon) Sore throat gargle (diluted TCP) Burns treatment Bites and sting cream (Eurax) Antihistamine tablets (Cetirizine) Hypoallergenic plasters Please tick the box to confirm you understand that any medication brought into school has to be declared to Miss Mialkowski (ashleigh.mialkowski@wychwoodschool.org) in writing detailing what the medication is for and instructions.*(Required) I confirm
