Taster Day Medical Form

Please complete the Medical Form below at least 48 hours in advance of your child’s Taster Day at Bilton Grange. If you have any concerns please do contact the School Nurse, Mrs Cathy Gunn on 01788 818234.

Step 1 of 2

Child's Details

Name(Required)

First Last

Date of Birth(Required)

Date of Discovery Session or Taster Day(Required)

Current Year Group(Required)

Any allergies?(Required)

Yes

Details of Allergies(Required)

Are there any medical issues we need to know about on the day?(Required)

Yes

Please detail any relevant medical information here(Required)

Please detail any dietary information here(Required)

Emergency Contact Details

Emergency Contact Name 1(Required)

First Last

Emergency Contact Email 1(Required)

Mobile Contact Number(Required)

Emergency Contact Name 2(Required)

First Last

Emergency Contact Email 2(Required)

Mobile Contact Number 2(Required)

Do you consent to medical/matronal staff administering First Aid Medical treatment if required? *(Required)

Yes

Do you consent to medical/matronal staff administering non-prescription medicines if required?(Required)

Yes

If you have given consent to the above and there are medicines which your child should not have, please list these below:(Required)

Electronic Signature(Required)

Please type your full name.

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Child's Details

Emergency Contact Details

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