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Medical Questionnaire
Medical Questionnaire
Medical Questionnaire
Medical Questionnaire
UTC Medical Questionnaire
Student First Name
*
Student Surname
*
Has your child had any of the following :
Asthma or Bronchitis
Heart condition
Seizures, fainting or blackouts
Severe headaches
Diabetes
Allergies to any known drugs or medication
Any other allergies e.g. materials, food, insect bites etc.
Other illness or disability
Any recent contact with contagious diseases and infections
If answer to any of these questions is yes please give details
Is your child receiving medical treatment of any kind from either your Family Doctor or Hospital?
*
Yes
N0
Has your child been given specific medical advice to follow in emergencies?
*
Yes
No
If the answer to either of these questions is YES please give the details below: (including dosage of any medicines/tablets)
Medicine
Any medicines that need to be taken during the school day must be handed to reception. The medicines should be in containers clearly labelled with the child’s name, the type of medicine and the dosage instructions. Please complete ‘Parental Agreement for Setting to Administer Medicine’ form for medication stored at school. (Available from reception)
Name
This field is for validation purposes and should be left unchanged.
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Home
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Welcome Guide
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Why UTC Leeds?
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Virtual Tour
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Student Destinations
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Curriculum
KS4
KS5
Summer School
Careers
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Parents
Parent Guide
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Safeguarding
SEND Information
College Day
KS4 Uniform
Sixth Form Uniform
Sixth Form Code of Conduct
Travel
Catering
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Parent Pay
Parent View
Calendar
Back
Industry Links
Employer Engagement
University Engagement
Industry Showcase
Industry Partners
Get Involved
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Vacancies
Contact Us
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Entry Requirements
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Year 10 Application Form
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