Relationship to Child. Date.....................................................
Relationship to Child. Date: ......................................................................... Parent/Carers signature................................................................
Relationship to Child. 2. Relationship to Child: Title: MRS MR MS MISS Title: MRS MR MS MISS Surname: Surname: First Names: First Names: Home Phone: Home Phone:
Relationship to Child. 2. Name: ………………………………………………….................. Telephone: ......………………………………….............................
Relationship to Child. Child(xxx)’s Doctor: ………………………………………....................... Telephone: .................…………….……….............................
Relationship to Child. CHILD’S AGREEMENT Proud To Be Me, Proud To Belong I will: attend school regularly and on time treat other people as I like to be treated and follow the school’s behaviour policy join the school in celebrating and enjoying the benefits of reading do all my classwork and homework as well as I can and challenge myself be polite and helpful to others take good care of the equipment and building be friendly, kind and respectful to all celebrate the differences between us all
Relationship to Child. Address I understand that I must deliver the medication personally to The School Office I accept that this is a service that Howbridge Infant School is not obliged to undertake. I understand that I must notify Howbridge Infant School of any changes in writing.
Relationship to Child. Any reference to parent/s contained in this contract shall mean both parents, i.e. both the mother and the father or legal guardian/s
Relationship to Child. 1 Please provide name and contact number in case of emergency: Yes/No 3 Are you taking steroids (or have in the last 2 years)? Yes/No 4 Any history of kidney or liver conditions? Yes/No 5 Have you ever had trouble with your heart? Yes/No 7 Any allergies (e.g. hay fever, eczema, food, medications, dressings, latex)? Yes/No 8 Do you suffer from high or low blood pressure? Yes/No 10 Do you have a Thyroid Problem? Yes/No 11 Do you have Arthritis - Rheumatoid or Osteoarthritis Yes/No 12 Have you ever injured or suffered from pain in the knees, hips or lower back? Which? Yes/No 13 Do you have or have you had Epilepsy? Yes/No 14 Do you have fainting attacks or blackouts? Yes/No 15 Have you had surgery or recently been in hospital? (Please specify in full) Yes/No 17 Do you have any other medical conditions that we should be aware of? Yes/No 18 Is there a history of illness in your family (e.g. heart disease, diabetes, cancer, other?) Yes/No 19 Do you use Tobacco products? Yes/No 20 Do you drink alcohol? How many units per week? Yes/No 21 Do you have any eyesight or hearing difficulties? Please say which Yes/No
Relationship to Child. I understand that this Shoreline Cooperative Preschool (SCP) is a cooperative preschool, and I agree to the following:
