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The codrington school: student's health record

The Codrington School: Student's Health Record

The following information is most important to the school. Please complete all parts fully and accurately. This
form must be completed and placed on file in the admission's office when the student enters school. This enables us
to care for your child. Please inform the director of admissions of any changes in the child's medical condition.

Child's first name
_____________________________________________________________________________________ Boy Girl Age _____________________________________________________________________________________ Nationality _____________________________________________________________________________________ Name of child's doctor _____________________________________________________________________________________ Doctor's business name and address _____________________________________________________________________________________ Emergency contact name
Medication permission
I hereby give permission for the above child to be given temporary medication by the school's administration,
including Tylenol, Calpol, Motrin, cough medication and antacids.

Accident/illness treatment permission
I understand that, whilst every effort will be made to contact parents or guardians in the event of an accident or
illness at school, sometimes emergency measures have to be taken immediately. I hereby give permission for
emergency measures to be initiated in the case of accident to or sudden illness of this child. In the case that
hospitalization is necessary I wish my child to be taken to ………………………………………………………
Please advise if you prefer a specific medical centre; otherwise, the child will be taken to FMH Emergency Clinic in
St Michael.
I hereby certify that all the information given on this form is correct, accurate and complete. I enclose the
doctor's report on this child.
Please state the initial dates of the last immunization boosters of the following: Please circle below if this child has/has had any of the following: Allergies Please comment on any circled items or any other conditions: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Does this child wear spectacles (glasses) or contact lenses? Is this child under special medical care? Does this child routinely take medicine? Does this child have any problems which adversely affect her/his ability to study? Is there any medical reason why this child cannot participate in physical education or sports? Does this child have any known allergies to medication? Is this child in good health, generally speaking? If you have answered "yes" to any of the above questions, please give brief details below: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Please complete both sides of this form and return before your child starts school. Thank you.


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