Visitor Medical Form – Bevendean Pre Prep Please enable JavaScript in your browser to complete this form. Please enable JavaScript in your browser to complete this form. Child's Name * First Last Child Date of Birth * Date of Visit * Address * Address Line 1 Address Line 2 City State / Province / Region Postal Code Mother Mobile * Father Mobile * Please give details of any medical history * Any Current Medical Conditions? Including medication prescribed * Has your child been diagnosed with asthma? Please include details of treatment/medication prescribed. * Does your child have any allergies? Please include details of treatment/medication prescribed. * Does your child have an adrenaline pen prescribed? * Yes No Any specific dietary requirements? * Are there any other health (physical mor mental) concerns, disabilities or family issues that your child may need support with? * Signature * Clear Signature Consent to general Treatment, Medication and First Aid I give consent for my son/daughter to receive any necessary emergency treatment, health care and/or first aid services provided at the School under the supervision of the registered School Nurse. He/she may be given first aid treatment by any qualified member of staff. This consent covers your son/daughter both in school and for any trip/activity/sport they may undertake that has been organised by the School and whilst under the care of school staff. Where appropriate he/she may be given non-prescribed medicines (homely remedies) to treat minor illness or injury. I automatically consent to the administration of over-the-counter preparations (listed in the Medical Centre Handbook). If you do not wish to give this consent, please state this separately in writing. I understand that essential medical information will be shared with school staff on a need-to-know basis to ensure the safety and welfare of my son/daughter. I understand it is my responsibility to inform the School Nurse in writing of any changes in my child’s health and mental wellbeing. Unless such notification is received, the school will rely upon the information contained in this medical form. I understand it is my responsibility to ensure that emergency medication prescribed for my child is supplied to the school and kept in-date. Any medication brought from home whether it be prescribed, over the counter or herbal, must be registered and stored in the Medical Centre. It must be accompanied by a pupil medication request form. The medicine must be in the original packaging stating generic drug name, dose and the pupil’s name. An English translation must be provided in the case of foreign medicines. I have provided full and complete information about my child in this Medical Form. All information on this form will be treated with confidence For more information about how the School may use your and your child's information contained in this form, please see our pupil privacy notice and our parent privacy notice which are available on the school website. Submit