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MENU
Our School
Headmaster’s Welcome
Ethos & Aims
History
Facilities
Senior Schools and Scholarships
Policies
Inspection Report
Admissions
How to apply
Open Days
Request a Prospectus
Fees
Scholarships & Bursaries
Uniform
International
Bus Routes
The Nest Pre-school
Pre-school Curriculum
Joining The Nest
FAQs
Pre-Prep
A Day at Pre-Prep
Pre-Prep Curriculum
Pre-Prep Performing Arts
Pre-Prep Sport
Outdoors
Pre-Prep Options
Prep
A Day at Prep
Prep Curriculum
Academic Departments
Prep Performing Arts
Prep Sport
P.E
Prep Art
Prep DT
High Flyers
Prep Options
School Life
Term Dates
Learning Support
Learning4Life
Our Food
Wraparound Care
Pastoral Care
BiG Saturday
Trips
Boarding
The Boarding Team
Boarding Pastoral Care
Outside School
News
Contact Us
Staff List
Vacancies
Friends of BG
Directions
Old Biltonians
Bilton Grange
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Online Joining Information and Forms
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Your Child’s Health
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Your Child’s Health
Please enable JavaScript in your browser to complete this form.
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Step
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Child's Name
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Last
Date of Birth
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Parent/Guardian Contact Email Address
*
Name and Address of Family Doctor
Town and Country of Birth
*
Please provide any details of any severe illnesses during infancy or early childhood
Please indicate if your child has ever had any of the following illnesses
Asthma
Appendicitis
Bronchitis
Chicken Pox
Epilepsy
Eczema
Hay Fever
Heart trouble
Jaundice
Kidney trouble
Measles
German Measles
Ear Trouble
Sleep Walking
Mumps
Pnuemonia
Scarlet Fever
Tonsilitis
Whooping Cough
Diabetes
Please indicate if your child is allergic to any of the following
Peanuts or other nuts
Pollen
Animals
Plants
Wasp/Bee stings
Other - please specify below
Other Allergens - please specify
Please provide details below of any operations or serious injuries.
Next
Does your child wear glasses
Yes
No
Date of last Optician visit. Please note that if glasses are worn by boarders a spare kept must be kept with Matron.
When were your child's teeth last examined and please note any issues below.
Does your child have any cultural or religious dietary needs?
Does your child have any other specific dietary needs?
Please note any issues with diet or digestion
Does your child have a tendency to constipation?
Yes
No
Do they suffer any pain after meals?
Yes
No
Do they have a tendancy to wet the bed?
Yes
No
If you are completing this form for your daughter, has she started menstruating?
Yes
No
Not Applicable
Next
Immunisation History
You should be able to find these dates in your child's Red Book, alternatively your GP will have a record of all immunisations.
Please confirm the date of Diptheria Vaccine
Please confirm the date of Tetanus Vaccine
Please confirm the date of Whooping Cough Vaccine
Please confirm the date of Hib Vaccine
Please confirm the date of Polio Vaccine
Please confirm the date of MMR (Measles/Mumps/Rubella)
Please confirm the date of Diptheria Booster Vaccine
Please confirm the date of Tetanus Booster Vaccine
Please confirm the date of Polio Booster Vaccine
Please confirm the date of MMR 2nd dose Vaccine
Please confirm the date of BCG Vaccine if applicable
Next
Please provide details of any drugs/medicines that your child is taking
Is there anything about your child's physical condition which should be known before they take part in competitive sports and games?
Please give the names, addresses, telephone numbers of any consultants or surgeons who have been called in at any time over the question of your child's health.
If you wish to expand on any of your answers given above, please do so here
Is there anything else that you wish to let us know?
Boarders Only: Please send your child's NHS Medical Card or provide the number below (Overseas children will be registered with the School Doctor). The School doctor will visit the School each term to carry out a medical examination on all new boarders.
Next
Consent to Treatment
I consent to the administration of non-prescription medicines
Yes
No
I consent to the administration of First Aid Treatment
Yes
No
I consent to the administration of Emergency Dental Treatment
Yes
No
I consent to the administration of normal treatments that might be prescribed by the School Doctor e.g. antibiotics or anaelgaesics
Yes
No
In the event that your child falls ill or suffers an injury at School please confirm your consent to the necessary treatment which may include, but are not limited to, anaesthetics, blood transfusions and any necessary surgical intervention. The School would make every effort to contact the parents in such a situation.
Yes
No
If you have not consented to any of the treatments listed above please provide more details below.
Parent / Guardian confirmation
Parent/Guardian Name
*
First
Last
Date / Time
Email
*
GDPR Agreement
*
I consent to this website storing my submitted information.
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