Medical Form

Medical Form
Child's name
Date of birth

MonthDayYear
Date
Doctor
Doctor's address
Doctor's telephone number
Does your child or the child in your care have any known medical problems or additional needs?
If the answer is yes, then please detail
Does your child take medication? (please provide full details. If medication is needed then an additional medication consent form will need to be completed)
Does your child have any known allergies? (an Allergy Management Plan will be put in place where required)
Does your child have any dietary requirements?
Any other information relevant to your childs health
In the event that my child is involved in a serious accident I expect to be contacted immediately on the telephone number on my registration form. In the event that my child requires immediate medical treatment before I can get to the hospital I hereby authorise the staff member present to consent to any emergency medical treatment necessary to ensure the health and safety of my child on my behalf.

Yes, I agree
Signature of ParentCarer

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Date

MonthDayYear
Date
Permission to Administer Medicine Form
Child's Name
Date of Birth
Child's Address
Parent's Contact Number
Doctor's Name
Telephone Number
Address of Surgery
Reason for Medicine
Name of Medicine
Storage Requirements
Dosage
Time to be Administered
I give permission for medicine to be given to my child in accordance with the details above.

·      Staff at the am.pm@WoolwellCentre will only be permitted to administer medication to your child if you complete and return this form.

·      Under no circumstances will members of staff administer medication against the will of a child.

·      We can only administer prescription medication if it has been prescribed for the child in question by a doctor, dentist, nurse or pharmacist.

·      Note that we can only administer medication containing aspirin if prescribed by a doctor.

If you have any concerns or questions, please contact the AM:PM @WoolwellCentre Manager.
Yes, I agree
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Medical Form

Permission to Administer Medicine Form