The school requires you to complete all sections of this form as fully as possible. The information provided by you in this form will help us to care for your child while they are a pupil at the School.
All information on this form will be treated in confidence.
For more information about how the School may use you and your child's information contained in this form, please see our pupil privacy notice and our parent privacy notice which are enclosed with the letter of offer and published on the School website under 'Admissions'.
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| Child's full name: |
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| Date of birth: |
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| Date of entry to Warwick School: |
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| Name of child's doctor: |
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| Address of child's doctor: |
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| Telephone number of child's doctor: |
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Eyesight and Hearing
If your child takes any medication for an eyesight or hearing condition, please provide details in the 'Medication' section of this form.
Infectious Conditions
If you need to provide us with further details, please do so in the 'Additional Information' section at the end of this form.
Allergies
If you answered 'Yes', please provide details in the 'Medication and Treatment' section of this form.
Other Conditions
If your child takes any medication or receives treatment for an above named condition, please provide details in the 'Medication and Treatment' section of this form.
Immunisation
The following table lists the routine and optional vaccinations (including travel vaccinations) available for children in the United Kingdom.
Please provide date(s) of immunisation of your child where indicated or, if immunisation not carried out, please state.
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| 5 in 1 Vaccine (Diphtheria, Tetanus, Whooping Cough, Polio, Hib) |
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| PCV (Pneumococcal Jab) |
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| Rotavirus |
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| Men B (Meningococcal Jab) |
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| Hib/Men C |
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| MMR (Measles, Mumps, Rubella) |
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| Children's Flu Vaccine |
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| 4 in 1 Pre-School Booster (Diphtheria, Tetanus, Whooping Cough, Polio) |
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| 3 in 1 Teenage Booster (Diphtheria, Tetanus, Polio) |
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| Meningitis (Meningococcal types A, C, W, Y) |
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Medication and Treatment
| | Name of medication/treatment | Reason for medication/treatment | Dosage (if applicable) | Frequency |
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Injuries, Accidents and Operations
Additional Information
I/We have provided full and complete information about my/our child in this 'Medical Information Form'.
I/We agree to inform the School in the event that my/our child's health or needs change.
I/We also agree to inform the School of any medication or treatment my/our child is receiving, as I understand that appropriately qualified School staff may administer medication or need to refer on.
Medical Consent
1. First Aid: I/We consent to appropriately trained and qualified members of the School staff administering first aid to my/our child where appropriate.
2. Medical treatment: I/We hereby give my/our consent for the School to act on my/our behalf as necessary for my child’s welfare if they require a medical examination, medical testing or minor medical treatment such as attendance at a local GP, Doctor or Optician.
3. Emergency treatment: I/We give my/our consent for the Head to act on our behalf to authorise emergency medical treatment as necessary for my child’s welfare in the event I/we cannot be contacted in time.
4. The administration of medicines: I/We hereby give consent for appropriately qualified members of the School staff to administer prescription medication as listed in the ‘Medication’ section of the ‘Medication and Treatment’ section of the ‘Medical Information Form’, or as subsequently notified to the School, and/or non-prescription medication such as Paracetamol, Ibuprofen, simple cough linctus, indigestion remedies and other over-the-counter remedies under protocols from the School Doctor for treating minor ailments.
