Health & Hauora Information
This information is required to help us care for our students. While this information is strictly confidential, it may be necessary for the safety of the student, or others, to inform relevant staff or medical personnel of medical conditions. Teachers may be informed of the conditions affecting the student’s education progress.

Sign in to Google to save your progress. Learn more
Student's Full Name (First and Last) *
Student's Date of Birth: *
MM
/
DD
/
YYYY
MEDICAL INFORMATION
Please tick if your child has any of the following:
Does your child take any regular prescription medication that we need to be aware of? *
If yes, please list the medication
Please list any food allergies/dietary requirements your child has:
ADDITIONAL LEARNING SUPPORT
Please indicate if your child has displayed (traits of) or been diagnosed with any of the following:
Has your child received any of the following supports?
Do you have any further information that we need to know to best support your child with their learning?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Te Puke High School. Report Abuse
Google Forms