MEDICAL INFORMATION
At St Bernadette Catholic Primary School we take every aspect of the health and welfare of your child very seriously. We therefore need to know about any medical condition your child suffers from and how this is treated. Please fill in this form as fully as you are able, and submit it back to school as soon as possible.

If this information changes at any time during the course of your child's time at school, please inform the Welfare Officer as soon as possible after the diagnosis. If you have ticked any of the boxes below apart from the last one, the Welfare Officer will contact you to discuss the options available for treating your child at School if there is a requirement to do so.

Please tick at least one box even if your child does not have any known medical conditions.
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Child's Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Does your child suffer from any of  the following conditions: (please tick one or more of these boxes) *
Required
If you have ticked any box apart from the last one, please provide details below-full description; treatment; if attending hospital which one and how often.
Parent's name *
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