JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Care Plan
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name of Child
*
Your answer
Year group and Class
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Child’s address
*
Your answer
Family contact details 1
*
Your answer
Family contact details 2
*
Your answer
GP details
*
Your answer
Name of Medical Condition
*
Your answer
Details of Medical Condition
*
Your answer
Name and dosage of any medication needed
*
Your answer
Does medicine have to be taken at a specific time of day?
*
Your answer
Self administration
*
Yes
No
Who should administer medication?
Your answer
Medication Expiry date
MM
/
DD
/
YYYY
Symptoms of condition
*
Your answer
Describe what constitutes an emergency and what actions should be taken if this occurs
*
Your answer
Who is responsible for providing support in school?
*
Your answer
Daily care requirements (if any)
*
Your answer
Who needs to know about this medical condition?
*
Your answer
Medical professionals working with child
*
Your answer
Additional information (if needed)
*
Your answer
School visit actions
*
Your answer
Details of main school contract including email address
*
Your answer
Date of plan
*
MM
/
DD
/
YYYY
Review date
MM
/
DD
/
YYYY
Signature
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Swale Academies Trust.
Report Abuse
Forms
