Joining Information - Health Form 1 - Little Grange Nursery

Health Details

Please indicate if your child has ever had or experienced any of the following:

If you ticked yes for any of the above, please provide more details here:

Has your child ever been referred to, or is your child currently seeing an external specialist:

If you selected yes to any of the above, please provide further details below:

Allergies: Please indicate if your child has a non-food related allergy to any of the following:

If you selected yes to any of the above allergies, please provide more details below:

Please indicate if your child has an allergy to any medicines:

Please provide details below:

Vaccinations

Please confirm if your child has had the following vaccinations and the date on which they were administered:

These are typically when your child will have these vaccinations: 8 weeks

Date Given

Date

Date Given

Please provide further details here:

Consents

Please complete the following consents:

If you have not consented to any of the treatments listed above please provide more details below:

If there is any further medical information that you wish to share with us, please do so here:

The Nursery needs to collect and retain child heath information to comply with its statutory duties and to keep children and others safe. The Nursery will ensure only authorised staff are provided with, or can access, such information on a need-to-know basis according to the circumstances and your child's needs. Please see our privacy notices for further information about the Nursery's processing of personal data.