Hooke Court - Medical Information

Please complete all the fields below - thank you

Child's Forename* Child's Surname* Please list any medical conditions or allergies your child currently has:*

Is your child currently taking any medication which will need to be administered whilst they are on the residential?*YesNo

If you answered YES above, please provide details below, including the name of the medicine, the amount to be given and the times it should be administered.*

Does your child have any special dietary requirements?*YesNo

If you answered YES above, please provide details below:*

Has your child spent a night away from home before?*YesNo

Please provide the name of your family GP, along with the surgery address and contact number:* Please provide the names and telephone numbers of at least two emergency contacts:* Any other information you feel may be relevant:*

GrayswoodChurch of England
Primary School

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Hooke Court - Medical Information