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AGS Confidential Medical Report

AGS Confidential Medical Report

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

    Other than above, in case parents/guardian are not contactable
  • Court orders relating to the child:

    If these orders change the powers of a parent/guardian to: • authorise the taking of the child outside the service by a staff member of the service • consent to the medical 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.
  • Drop files here or
    Please upload the original court order/s for administration to verify and a copy for to this enrolment procedure.
  • Family Doctor

  • 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).
  • 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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