Medical Form

Immersion Programme Medical/Dietary information

Please answer all of the questions. It is the parents/guardians responsibility to disclose, in confidence, on this form any circumstances which may affect the health, pastoral, educational welfare, care and management of any student joining the Ratcliffe College Immersion Programme.

Is your child fit to take part in the Ratcliffe College Immersion Programme daily schedule, including sports / games?(Required)

Yes

Does your child have any allergies (e.g. penicillin). If NO, please state N/A. If YES, please give details:(Required)

Does your child require any treatment for this condition? If NO, please state N/A. If YES, please give details:(Required)

Does your child have any special dietary requirements? If NO, please state N/A. If YES, please give details:(Required)

Does your child have a medical condition/health concern? If NO, please state N/A. If YES, please give details:(Required)

Does your child take medication during the school day? If NO, please state N/A. If YES, please give details:(Required)

Is there any further information about the student of which the Immersion Programme staff should be aware of?(Required)

I provide consent for basic first aid to be administered to my child:

Yes

In the case of an emergency, staff will do everything reasonable to contact the parent/guardians named above.

Yes, I consent

No, I do not consent

In circumstances where medical treatment is required immediately and where it is not possible to contact those named on this form, I authorise the leader in charge of the group to refer my child to a medical practitioner or emergency services on my/our behalf and to sign on my behalf any written consent required in the event of a life-threatening injury/condition.