Contact details and medical emergency form | Rydes Hill Preparatory School & Nursery

Child's details

Your child's full name (as per passport)

Nationality

Date of birth

Child's class

If your child has not yet started at Rydes Hill please state N/A

Please tick the appropriate box to show the child’s ethnic group (please only tick one box). We have a legal requirement to collect this information for our annual census

Please select

Caribbean

African

Any other Black, Black British or Caribbean background

Please select

White and Black Carribean

White and Black African

White and Asian

Any other mixed or multiple ethnic background

Please select

Arab

Any other ethnic group

Child's medical details

Name of family doctor or surgery

Surgery telephone number

Does your child have any existing medical conditions including allergies?

Yes - please specify below

Additional information on your child's medical conditions

Please explain any emergency procedures for existing medical conditions

Does your child take any regular medication or require the use of an EpiPen?

Yes - please specify below

Additional information on the medication your child takes or the use of an EpiPen

Is there any medication that your child is unable to tolerate?

Has your child ever had asthma?

Yes

Has your child had an eye test within the last year?

Yes

Please explain why your child has not had a recent eye test

Does your child need to wear glasses?

Yes

Please state how long they need to wear glasses and what for

Please state if your child has a history of ear infections and/or grommets or any hearing difficulties.

Please share any of your child's medical history which you believe is relevant for us to be aware of.

Medicines

Except for inhalers, pupils must not carry or administer their own medicine. Guidelines from the Department of Education advise teachers not to administer medicine. If, in exceptional cases, you request a medicine to be administered, this must be handed into the school office. It must be clearly marked with the child’s name, dosage and time to be administered. You will be asked to sign a Medical Procedures form for each administration and parents take full responsibility for these administrations. All medicines must be collected by an adult at the end of each day.

In the event of your child having a stomach bug, on recovery please ensure that a period of 48 hours elapses before they return to school.

All parents are requested to complete an this form at the beginning of each academic year. It is vital that all information on this form is accurate. Please be assured that all medical records are dealt with the strictest confidence.

I understand

Parent or guardian declaration

Your full name including title

Your relationship to child

I have noted above any medical problems that might affect my child.

I understand that those supervising my child are in loco parentis and must exercise a standard of care that would be expected of a reasonably prudent parent. My child is fit to participate in all aspects of the school curriculum.

Parent and nominated person details

Parent 1

Your full name

Your relationship to child

Contact telephone number

Parent 2

Full name

Relationship to child

Contact telephone number

Who does your child normally live with?

Mother

Father

Both

Other

First nominated person in loco parentis and living locally i.e. grandparent

Full name

Relationship to child

Contact telephone number

Second nominated person in loco parentis and living locally i.e. grandparent

Full name

Relationship to child

Contact telephone number

The information you are about to submit will be used to effectively handle your enquiry in accordance with the school’s admissions process. This may include email, phone and postal correspondence.

We promise to treat your personal details with the utmost care and will never share or sell your data to third parties.

You can read our Privacy Policy, here.

I am happy for my data to be processed.