St. Michael's School, 198 Hadleigh Road, Leigh-on-Sea, Essex SS9 2LP  Tel: 01702 478719  
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 Online Medical Form
Please complete the form as fully as possible and return it to school useing this online form. If your child does not have any known medical conditions, food allergies, special dietary requirements or medication please put NONE. If any information changes, please notify the school, in writing or refilling in the online form below, so that your child’s records can be amended.
Thank you.


Childs Name:

Known allergies, including food allergies, or medical conditions (e.g. asthma):


Special dietary requirements:


Medication or special treatment, if any, required at school (including inhalers):


I confirm that by submitting this form I give consent for the school to give my child Calpol or Piriton if they become unwell during the day provided that verbal permission is given by me or one of my designates prior to administration of medication. In the case of an emergency, I give permission to the school to seek any necessary emergency medical advice or treatment in the future. I understand that the school will make every effort to contact me first.

Agree to above statment:

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