Does your child take daily prescribed medication at home? *
Yes
No
Does your child require and prescribed medication at School *
Yes
No
Does your child have any dietary requirements? *
Yes
No
I give permission for the administration of Panadol (analgesic) *
Yes
No
I give permission for the administration of Clarityne (Antihistamine) *
Yes
No
I give permission for the administration of Motion sickness relief *
Yes
No
Please indicate your child’s swimming ability. *
Non-swimmer
Is able to swim 25 m unassisted
Is able to swim 50 m unassisted
Can swim competently
Please provide any other information, that the teacher-in-charge/ nurse should be aware of for the safety and well being of your child.