Taster P1 Form - Greenfield School

Child's Name

First

Last

Child's Date of Birth:

Please give details of all medical conditions/ailments/illnesses that your child currently has, or previous conditions that the school should be aware of:

Does your child have any medication?

Yes
No

Will your child need to have medication administered in school, or medication kept in school during their visit (e.g. an inhaler, epipen)?

Yes
No

Please complete the form below to accompany the medication your child will be bringing with them.

Click here for Medication Form

Does your child have any dietary requirements?

Yes
No

Are your child's dietary requirements due to allergies or intolerances?

Yes
No

Please give details of your child's dietary requirements:

Parent/Guardian telephone number(s):

In the event of the school being unable to contact parent/guardians, please give contact details of someone who will act "in loco parentis". This should be a person other than the parents.

Name of Emergency Contact:

First

Last

Relation to child:

Emergency Contact Telephone: