Student Medical Records Form

To ensure your child receives comprehensive health care in the event of an illness or injury in school or whilst participating on a school trip, please answer every question fully. This information will be shared with the treating medical authorities present at the time

Personal Information

Student first name *

Student surname *

Date of Birth * +

Year group *

Gender *

Male

Female

Mother's first name *

Mother's surname *

Mother's Mobile number *

Mother's email address *

Father's first name *

Father's surname *

Father's mobile number *

Father's email address *

Emergency Contact Information

Emergency contact first name *

Emergency contact surname *

Emergency contact mobile number *

Student home address

Street Address *

Address Line 2

Address Line 3 *

Student vaccination Details

Vaccine schedules differ from one country to another due to particular health concerns of each country. Please see UAE schedule for your reference: Children's health - The Official Portal of the UAE Government

The Health Authority requires that the school maintains current information of each child’s immunisation history.

Therefore, we require you to update them throughout their time in school.

Please upload a copy of your child's current immunisation record *

I confirm that the attached photocopy is a true copy of my child’s immunisation record.

Parent first name *

Parent surname *

Parent signature *

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School Health Screening Consent 2023/24

The Department of Health-Abu Dhabi mandates that all children in Years 1-13 are screened annually for health concerns. This screening includes height, weight and body mass index. All results are recorded and transferred to the Department of Health-Abu Dhabi as mandated.

I consent to my child being included in the mandated health screening as outlined above.

Parent first name

Parent surname

Parent signature

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Student Medical History

Does your child have any of the following medical conditions: *

Cause *

Reaction *

Treatment *

Cause

Reaction

Treatment

Please provide further details *

Does your child suffer from any other chronic diseases not listed above? *

Yes

No

Please provide further details *

Does your child take medication on a daily basis? *

Yes

No

Medication name *

Used to treat *

Dose/time *

Medication name

Used to treat

Dose/time

Please provide further details. If medication is needed to be taken during the school day, you will be asked to complete a Consent for Prescription Medication Form when you give the medication to the school nurses. *

Does your child have visual difficulties? *

Yes

No

Do they wear? *

Glasses

Contact lenses

None of the above

Is your child receiving current or ongoing treatment for any medical, surgical or psychological condition? *

Yes

No

Please give full details *

Please provide a recent medical report from the treating doctor/hospital *

Consent for the Administration of Medications and Emergency Treatment

In the event that your child becomes unwell, or he/she has injured him/herself, it may be necessary to administer specific medication or undertake treatment.

This is to authorise the School Nurse or trip leader to administer the appropriate treatment for the various situations that may arise.

If your child is unable to use any of these medications, please contact the School Nurse to discuss the use of an alternative.

I have read and understood the list of the medications or solutions used at the School.

I consent to my child being given the above age-appropriate medications should it be considered necessary.

In the event of an emergency, I consent for my child to be taken to a doctor or hospital for diagnosis and treatment.

Parent first name *

Parent surname *

Parent email address *

Parent signature *

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