JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Medical Form - Kingswood
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's name
*
Your answer
Class
*
Woodpeckers
Owls
Home telephone number
*
Your answer
Mobile telephone number
*
Your answer
Name and telephone number of alternative contact in an emergency:
*
Your answer
Doctor’s name & telephone number:
*
Your answer
Medical requirements/Notes i.e. Asthma, allergies etc.
Medical requirements/Notes i.e. Asthma, allergies etc. (please include details of medicines your child will need to take to Kingswood)
Your answer
Dietary Information: i.e. Vegetarian, any food allergies or dislikes:
Your answer
My child is in good health and I consider him/her fit to participate.In the event of an accident or illness I consent to any necessary medical treatment which might include the use of anaesthetics.
*
Yes
No
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of St Fidelis Catholic Primary School.
Report Abuse
Forms
