Health Form

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Health Form

* Indicates required field

Student's Name *

First

Last

Grade *

Student's CPR No. *

National ID Number.

Note:
If there is any medical condition that is not included, please let us know in writing or by providing a medical certificate.
If medication is required to be given, please provide a copy of detailed written prescription to the school by either email (click here) or paying us a visit.

Date of Birth

Day *

Month *

Year *

Emergency Telephone No. *

Home Telephone No. *

Father's Name *

Mother's Name *

House/Flat *

Building *

Road *

Block *

Area *

P.O. Box *

Any behavioural complaints from previous schools: *

Note: the information listed below must be determined by your Pediatrician/Family Doctor

Weight (kgs) *

Height (ft) *

History of Disease leading to hospitalization: *

Yes No

If yes, please provide details: *

Family disease History: *

Yes No

If yes, please provide details: *

Any Chronic Disease? *

Yes No

If yes, please provide details: *

History of Atopy? *

Yes No

the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema).

If yes, please provide details: *

Any Allergies? *

Yes No

If yes, please provide details in full:

Food *

Please provide the specific foods the applicant is allergic to.

Weather *

Please specify any weather conditions the applicant is allergic to.

Milk *

Please provide the specific type of milk the applicant is allergic to or details about the allergy.

Medication *

Please outline any medications the applicant is allergic to.

Dust *

Please provide details if the applicant is allergic to dust.

Other (please specify): *

History of the following:

Please type 'none' if there was no occurrence.

Asthma *

Blood Disorder *

Metabolic Disorder *

Sickle Cell TH *

Heart Disease *

Lung Disease *

Seizure/Neurologic Disorder *

E.g. epilepsy. If none, type in 'none'.

Personality/Behavioral Disorder *

Epistaxis/Nose Bleeding *

Skin Disease *

Bone/Muscular Disease *

Others (please specify) *

Medication and Dosage:

Is the applicant taking any regular medication? *

Yes No

If yes, it is important that you fill in the details below and provide us with a copy of detailed written prescription.

Daily supplement or medication given: *

Time and Frequency: *

Dosage: *

Submit

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Mission

Our mission is to provide a child centred and developmentally appropriate programme, in a safe, secure, and positive environment, which promotes personal growth with strong moral values and a passion for life long learning.

رسالتنا هي أن نووفر برنامجاً ملائماً متطوراً و متمركزاً حول الطفل في بيئة آمنة وإيجابية, تعزز النمو الشخصي بقيم أخلاقية قوية و شغف شديد للتعلم مدى الحياة.

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Home
Little Us
Fees and Registration
- Registration
- Fees
COVID-19 PRECAUTIONS
Little Shop
Survey