WBHS Health and Medical Profile 
This information will be stored in Kamar to help us ensure we have all the information regarding your son.  It is important that it is kept up to date so if anything changes, please let the whanau teacher know.
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Email *
Student Last Name: *
Student First Name *
Whanau Group *
Medic Alert number (leave blank if not applicable)
Does your son suffer from any of the following medical conditions? *
Required
Is your son taking any medication? *
Name of medication(s)
Dosage and time(s) to be taken
Other treatment
Is a Health Plan required? *
Has your son had any injuries or illness in the past 6 months that may limit full participation in any activities? *
If yes, please give brief details
Is your son allergic to any of the following?
Please give details about their allergy and treatment here
How well can your son swim? *
When was your sons' last tetanus injection (if known)?
Is there any information the staff should know to ensure the physical and emotional safety of you/your child? (For example cultural practices; disability; anxiety; about heights/darkness/small spaces; behaviour or emotional problems *
If Yes, please give brief details
I agree that if prescribed medication needs to be administered, a designated adult will be assigned to do this. I will ensure that prescribed medication is clearly labelled, securely fastened and handed to the designated adult with instructions on its administration *
I will inform the school as soon as possible of any changes in the medical or other circumstances *
I agree to my child/myself receiving any emergency medical, dental, or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present *
Any medical costs not covered by ACC or a community service card will be paid by me *
Your contact phone number *
Electronic Signature - By writing your full name below you agree that you have answered the above questions to the best of your ability, and that all answers are true and correct *
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