Read-only Browsing: Please complete the first section of the form in order to edit subsequent sections.
Confidential Medical Record
Vaccination Record

Please give dates for the following vaccinations.

Please note: A BCG vaccination is a vaccination against Tuberculosis. This is not given in North America but it is common in Africa, Asia and other parts of Europe and Great Britain

ONLY PDF file size below 5mb.

Health Questionnaire

To be completed by the parents or guardians.

Other Pertinent Medical Information

I / We request that our child be registered as a prospective student.

I / We understand that the school may obtain, process and hold personal information about me / us, including sensitive information such as medical details, and I / We consent to this for the purposes of assessment, and, if a place is later offered, in order to promote and safeguard the welfare of the child.

I declare that all the information provided is correct and understand that false, inaccurate or misleading information could result in the student’s withdrawal from school.

Date: Sep 20, 2019