Medical Consent Form

Medical Consent Form
Please have these forms completed by a physician. You can do so by printing the form out and having your physician complete it manually, or by typing in the results of the recent physical report your physician has carried out on your child. "Print Form" button is available at the end of this form. Please provide the information in English or in Medical Terminology.

Personal Information
Student Name
First NameLast Name
Parent Name
First NameLast Name
Phone Number
Area CodePhone Number
Contact E-mail

Medical History
Please provide necessary medical history information that has, does, or could affect your child.
Please provide more detailed information

Physical Examination
Height
cm
Weight
kg
Blood
pressure
Skin
condition
Throat
condition
Teeth
condition
Ears
condition
Lungs
condition
Vision
condition
Heart
condition
Abdomen
condition
Hernia
condition
Urine
condition
Indigestion
condition
General Condition

Medical Permission
I hereby give my permission to the school for my child to:
1
Parent / Guardian
Should be Empty: