James Dixon Forest School Medical Form

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This form is a required document for your child to go to Forest School.

This will be used throughout your child's time at James Dixon, you would only need to fill the form again if there are any changes.

Child's First Name *

Child's Surname *

Child's Class *

Date of Birth *

YYYY

Address *

Emergency Contact Name *

Emergency Contact Number *

Doctors Name and Surgery Number *

Has your child any of the following *

Asthma or chronic bronchitis

Sight or hearing issues

Heart condition

Seizures,fainting or blackouts

Diabetes

None

Other:

Required

Any allergies (this includes medicines) *

Tetanus vaccination *

Yes

Maybe

Does your child have any fears which may affect their enjoyment of Forest School *

I agree for my child to take part in Forest School and know of no medical reasons why my child should not participate. Please confirm your name to give permission *

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