Abcc Enrolment Form - 2017 Page 3

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D
?:
 Yes
 No
OES YOUR CHILD HAVE ANY SPECIFIC DIETARY REQUIREMENTS
D
?:
 Yes
 No
OES YOUR CHILD HAVE ANY FOOD INTOLERANCES
I
,
:
F YES
PROVIDE DETAILS
I
,
/
?:
 Yes
 No
F YES
IS THE INTOLERANCE
ALLERGY LIFE THREATENING
F
I
/A
M
:
 Yes
 No
OOD
NTOLERANCE
LLERGY
ANAGEMENT PLAN SUPPLIED
M
P
1
ANAGEMENT
LAN VALID FOR
YEAR FROM ISSUE
I
4 (
),
F YOU HAVE ANSWERED YES TO ANY QUESTIONS IN SECTION
EXCLUDING IMMUNIZATION INFORMATION
PLEASE COMPLETE SECTION BELOW ONLY ON RECEIPT OF
ABCC
.
DOCUMENTS FROM
STAFF
M
C
A
EDICAL
ONDITION
DDENDUM
2.1, 2.2 & 2.3
.
THIS SECTION NEEDS TO BE SIGNED ON RECEIPT OF POLICIES
AND IN THE PRESENCE OF A COLLEGE STAFF MEMBER
If this enrolment form contains any YES answers in the Health & Medical Details Section, then the Nominated Supervisor must ensure families
receive the following information and that parent/guardians have read and understood the following information by signing and dating:
P
/ G
:
ARENT
UARDIAN
:
:
:
NAME
SIGNED
DATE
I have received a copy of the following ABCC Policies and Procedure documents
2.2 Medical Conditions Policy
2.3 Administering Medication Policy
2.4 Anaphylaxis and Other Medical Issues Management Plan
:
WITNESS
:
:
:
NAME
SIGNED
DATE
M
(
)
EDICAL PRACTITIONER DETAILS
MINIMUM ONE REQUIRED
Doctor 1
Doctor 2
N
:
N
:
AME
AME
S
N
:
S
N
:
URGERY
AME
URGERY
AME
A
:
A
:
DDRESS
DDRESS
P
:
P
:
HONE
HONE
F
M
N
:
AMILY
EDICARE
O
A
DDITIONAL INFORMATION
D
/
?
 Yes
 No
OES YOUR CHILD HAVE ANY RELIGIOUS
CULTURAL NEEDS
I
,
:
F YES
PROVIDE DETAILS
D
,
?:
 Yes
 No
OES YOUR CHILD HAVE ANY DISLIKES
FEARS OR PHOBIAS
I
,
:
F YES
PROVIDE DETAILS
I
T
S
I
?:
 Yes
 No
S YOUR CHILD OF ABORIGINAL OR
ORRES
TRAIT
SLANDER DESCENT
I
-E
?:
 Yes
 No
S YOUR CHILD FROM A NON
NGLISH SPEAKING BACKGROUND
I
, N
:
F YES
ATIONALITY
W
G
ABCC
?:
 Yes
 No
OULD YOU LIKE INFORMATION FROM
OVERNMENT REGULATORS OR ADDITIONAL
INFORMATION
I
,
E
?:
 Yes
 No
F POSSIBLE
DO YOU REQUIRE A LANGUAGE OTHER THAN
NGLISH
3
St John’s Anglican College ABCC & St John’s EY ABCC

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