Health Declaration Form

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Beavers Academy

Beavers Academy Health Declaration Form

Beavers Academy Child Health Declaration Form

Name of Child……………………………………………………………………………

Date of Birth……………………………………………………Age……………………

 

Allergies…………………………………………………………………………………

 

Is your child left handed or right handed? ……………………………………………..

 

Please state if you child/ren has experienced any of the following in the last 18 months:

 

Category

Yes /No

Provide Dates

Notes

Asthma

 

 

 

 

Allergies

 

 

 

 

Constipation

 

 

 

 

Convulsion/Seizures

 

 

 

 

Diabetes

 

 

 

 

Difficulties with:

·      Chesty coughs

·      Sight/vision

·      Hearing

·      Speech

·      Mobility

·      Eating

 

 

 

Epilepsy

 

 

 

 

Heart/Lung Condition

 

 

 

 

Malaria

 

 

 

 

Typhoid

 

 

 

 

Nose Bleeds

 

 

 

 

Hospitalisation

(Reasons)

 

 

 

 

Please indicate if your child is on any type of medication.

 

 

 

 

 

Beavers Academy Emergency Consent Form

 

I/we (name of parent/s) ………………………………………………………………………………………..…

…………………………………………………………………………………………..

 

Give permission to Beavers Academy to undertake the necessary first response actions in the event of any health emergency concerning my:

 

Child/ren………………………………………………………………………………..

 

I also consent, for my child to be taken to the nearest hospital, should his/her situation become life threatening.  

 

Beavers Academy is authorised to administer Paracetamol Syrup/Calpol to reduce my child’s temperature, should the need arise.

 

Please be reminded to boost your child’s immune system by giving him/her multivitamins.

 

Please keep your child at home if he/she has an infection or any communicable diseases/illnesses.

 

In the event of any health emergency the following individual(s) should be contacted: (Please provide name and contact number)

 

  1.  

 

  1.  

 

 

Signed…………………………………………………………………………………

 

Date……………………………………………………………………………………

 

 

Signed………………………………………………………………………………….

 

Date……………………………………………………………………………………

 

    1. Sponsorship

     

    Throughout the year, the management of Beavers Academy appeal to friends of the Academy for financial support to assist families in extreme hardship, as a result of major changes in their circumstances.

     

    Should funds be donated, Beavers Academy Management will make the decision regarding who would be eligible for support, with payment strictly towards payment of fees.

     

    Parents would be notified of the amount awarded and informed of the period of time the support would cover.

     

    1. Refund or waiver of school fees

     

    Save where there is a legal liability under a court order or under the provisions of this agreement to make a refund, fees will not be refunded or waived if:

     

    • The school is temporarily closed due, for example, to adverse weather conditions;
    • A parent has removed their child/ren before the normal end of the school day/term; or
    • The pupil is absent through illness; or
    • A term is shortened or a vacation extended; or
    • For any other reasonable reason.

     

    1. Information Sharing

     

    As part of the admission process, Beavers Academy may verify from the child’s previous schools that all outstanding balances have been paid.

     

    If a child is leaving Beavers Academy with an outstanding debt, the forwarding school will also be informed. 

     

    1. Fee increases and payment terms

     

    Fees are reviewed annually and are subject to increase from time to time, but no less than one term’s notice will be provided about any such changes. The fee payment terms will be reviewed termly.