Student Medical Information (Confidential)

The Academy will deem the person who has completed this form (which should be the Parent/Carer) to have provided accurate information in every section and, as such, we will take submission of this form to act as a signature from that person that this is the case
Current IllnessOver 5 yrs agoOver 10 yrs agoN/a
Asthma *
Diabetes *
Epilepsy *
Eczema *
Anxiety *
Depression *
Cardiac - please specify below *
Allergies - please specify below *
Other illness - please specify below *
Please indicate if you would like the Academy Medical Officer to contact you to discuss any issues or concerns that you may have