Medical Information
Student's Full Name
First Name
Last Name
Name of doctor (in home country)
Phone number of doctor:
Please enter a valid phone number.
Enter below any history of previous illness that may affect their enrolment, including mental illness.
Email any additional pages required to info@lac.school.nz
Please tick the appropriate box if you suffer from or have suffered from any of the following medical conditions:
Asthma
Back/Neck problems
Glandular Fever
Allergy to bee/wasp stings
Migraines
HIV or Aids
Diabetes
Hepatitis A, B or C
Epilepsy
Heart Condition
Tuberculosis
ADD or ADHD
Allergies
Food Allergies
Eating Disorder
Depression/Anxiety
Other: (Please describe)
Enter below any medical implants (such as metal implants) that may affect receiving medical treatment while in New Zealand?
Email any additional pages required to info@lac.school.nz
Enter below any current medication.
Email any additional pages required to info@lac.school.nz
Enter below any further medical information that the school needs to be aware of in enrolling and supporting the student as an international student.
Email any additional pages required to info@lac.school.nz
Do you consent to the school providing over-the-counter medication *such as acetaminophen, paracetamol or ibuprofen?
Yes
No
If ‘No’ please specify what medications you do not want the Student to receive
Submit
Should be Empty: