Health Declaration Form

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Health Declaration Form

Please fill in this Health Declaration form to ensure that we have specific risk assessments in place if needed.

ALL MEDICAL INFORMATION IS TREATED AS CONFIDENTIAL – the information supplied will only be seen by the preschool manager and deputy, the administrator, and if appropriate by your child's key person.

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* Indicates required question

Child's Name *

Your answer

Child Date of Birth *

MM

/

DD

/

YYYY

Name & Address of Child's GP *

Your answer

GP Contact number *

Your answer

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