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AGS Confidential Medical Report – Primary

AGS Confidential Medical Report - Primary

This report is intended to assist the School in the case of any Medical Emergency with your child. All information is held in confidence. This report is kept on file. A copy may accompany the student if transport to a hospital or a local medical practice is required (please print and use black/blue pen only).
  • Date Format: DD slash MM slash YYYY
  • Parent 1/ Guardian 1 / Carer 1

  • Parent 2/ Guardian 2 / Carer 2

  • Emergency Contacts

    In case parents/guardians are not contactable, please provide details for a suitable adult to be contacted.
  • Court orders relating to the child:

  • Drop files here or
    Please upload the original court order/s for administration to verify and a copy for to this enrolment procedure.
  • Please describe these changes (i.e. to treatment of the child; request or permit the administering of medication to the child; collect the child and/or give these powers to someone else) and provide the contact details of any person given these powers.
  • Family Doctor

  • Date Format: MM slash DD slash YYYY
  • Medical History

  • Medication:

    Medication that is to be given by the Registered Nurse for any condition, must be provided by the parents along with the completed documentation (AGS Medication Administration Authorisation form). Please contact School Nurse if required.
  • Diet:

  • Swimming Ability:

  • Other

    Please list any other information of which the School should be aware of, including any special needs or disabilities requiring assistance:

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