Health Declaration Form

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Beavers Academy Health Declaration Form

Beavers Academy

Beavers Academy Child Health Declaration Form

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

Category Yes/No Provide Dates Notes
Athma
Allergies
Constipation
Convulsion/Seizures
Diabetes
Difficulties with:
Epilepsy
Heart/Lung Condition
Malaria
Nose Bleeds
Typhoid
Hospitalisation (Reasons)