Medical Information Form
To be completed by Parents/Guardians on behalf of each child.
Information provided below will be treated with confidentiality. It will be used for the purpose of planning safe activities, or in the event of a medical situation arising at school or away on a trip.
Student Details
Parent Contact
Family Doctor
Health Cover Details
Do you have private health cover?

Emergency contacts below should be people OTHER than parents who may be contacted in the event that the College cannot reach a parent in an emergency situation.
Emergency Contact Details (other than parent)
Contact One
Contact Two
Contact Three

Is your child currently taking any medication?
Does your child have any condition or disability at present?

Has your child ever suffered from, or now suffers any of the disorders listed below?

Check the appropriate boxes

Additional Medical Information
Allergy Details (if applicable)
Asthma Plan Provided
Ventolin Provided
Anaphylaxis Action Plan Provided
Anaphylaxis Medication Provided
Allergic Reaction Action Plan Provided
Allergic Reaction Medication Provided
*
If you have letters or reports from specialists pertaining to your child's medical or academic needs, or a medical action plan please attach copies below.
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