Medical Form

Student's Details



Does your child have an allergic reaction to any of the following? If yes, please provide details:

Penicillin *
Elastoplast *
Nuts *
Shellfish *
Dairy Products *
Suntan Lotion *
Insect Bites or Stings *
Pollen (Hay fever) *
Paracetamol *
Has your child ever been prescribed an Epi-Pen? *

Medical Conditions

Has your child broken any bones in the last 6 months? *
Has your child been unconscious or received a head injury in the last 6 months? *
Has your child had a surgical procedure in the last 6 months? *
Has your child suffered from any contagious disease or infection recently? *
Is your child currently taking any medication prescribed by a doctor? *
Is your child taking any medication or supplements not prescribed by a doctor? *
Does your child suffer from neck or back pains? *
Is your child colour blind? *
Is your child diabetic? *
Is your child epileptic? *
Is your child asthmatic? *
Does your child suffer from any other medical condition? *


If your child is taking any medication please complete the table below. Please note that all medication and supplements should be handed in to the relevant medical staff on arrival at school. Medical staff and/or host families will keep these items secure and ensure that the correct dosage is available.

Name of Medication (in English)

Medical Condition

Dosage and Time

You will be contacted if additional information is required.


Special Educational Needs

Does your child have and Special Educational Needs we should be made aware of, such as dyslexia or autism? *


Please sign the form below to confirm that you have read, understood and accept the following:

  1. Appropriate medical treatment will be administered to my child by a responsible adult as is deemed necessary, in an emergency or otherwise, or upon the advice of a qualified medical practitioner.
  2. In the event of an injury, my child will be given appropriate first aid treatment.
  3. My child can be given, where necessary, appropriate over-the-counter medication in accordance with instructions with usage.
  4. My child will hand in any medication and/or supplements, prescribed or non-prescribed, to the relevant medical staff upon arrival at school or with a host family.
  5. I understand that my child's medical information will be kept confidential and only shared on a need to know basis with relevant staff, host families, medical professionals or emergency services.