Taster Day Medical Form

Please complete the Medical Form below 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.

Name *

First

Last

Date of Birth//

Any allergies *

Are there any medical issues we need to know about on the day? *

Emergency Contact Name 1: *

First

Last

Emergency Contact Number 1: *

Emergency Contact Name 2: *

First

Last

Emergency Contact Number 2

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

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

If you have given consent to the above and there are medicines which your child should have, please list these below:

Signature

Date

The information requested on this form is needed because the School has contractual and statutory duties towards your child. For more information about how the School will use your information, and your child's information, please see our privacy notice. This document is provided with the letter of offer and published on the School's website: www.biltongrange.co.uk/admissions/privacy-notice/

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