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Contact us
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MENU
MENU
About Us
Welcome to The King Alfred School
Our Philosophy & Aims
The KAS Deeper Learning Wheel
Exam Results & Student Destinations
Term Dates
Development
Help Us Shape Our Futures
Diversity, Equity, Inclusion & Belonging
Partnerships
ISI Inspection
Safeguarding at KAS
Policies
KASparents
Governance
AGM 2024 – Results
Council Member Profiles
Staff Vacancies
Admissions
Open Days
View our Prospectus
Virtual Tours
Entry at 4+
Reception Application Form
Entry at 11+
Entry at 16+
Sixth Form Entry Application Form
Occasional Places
Occasional Places Application Form
Fees & Bursaries
Good Schools Guide Review
Lower School
Life in Lower School
Lower School Curriculum
Lower School Pastoral Care
Lower School Extra-Curricular
Upper School
Curriculum: Years 7, 8 & 9
Year 10 & 11 Options
Upper School Pastoral Care
Upper School Extra-Curricular
The Village Project
Sixth Form
Sixth Form Stories: Live Your True Colours
A Level (and equivalent) Courses
UAL Level 3 Extended Diploma in Performing & Production Arts
Careers Advice
Sixth Form Pastoral Care
Sixth Form Extra-Curricular
Old Alfredians
OA News
OA Newsletter Archive
KAS Connected
Forthcoming Events
Memories of Old Alfredians
Old Alfredians Contact Form
KAS 125
KAS 125 Book
KAS In 125 Artefacts
KAS 125 History
KAS 125 Artwork
News & Events
Weekly Lunch Menu
Sports Fixtures
A Guide To SOCS
Term Dates
School Publications
School Films
Contact us
Phoenix Theatre hire
Staff List
Parent Portal
Parent Portal – A Guide
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King Alfred Medical Questionnaire – Confidential
King Alfred Medical Questionnaire – Confidential
Please enable JavaScript in your browser to complete this form.
Child's Full Name
*
Date of Birth
*
Year Group
*
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Start Date (If new pupil)
Name of Child's GP
*
Address of Child's GP
*
Address Line 1
Address Line 2
City
County
Post Code
GP Surgery Phone Number
*
Has your child suffered from any of these conditions/illnesses? (Please comment in the box below if you wish, where indicated
*
Chickenpox
Rubella
Measles
Whooping Cough
Mumps
Scarlet Fever
Glandular Fever
Hepatitis
Tuberculosis
Meningitis
Encephalitis
Diabetes
Asthma
Pneumonia/Bronchitis
Epilepsy (fits or other)
Blood/Bleeding Disorder
Kidney/Urine Disorder
Skin Complaint
Hay fever
Migraine
Suspected Food Allergy
Dietary Requirements i.e. Gluten free, Vegan etc
None of the above
Comments on Medical Conditions above, or suffered with any other conditions not listed above
Vision
Does your child wear spectacles?
*
Yes
No
Do parents wear spectacles?
*
Neither
Both
One
When was your child's eyesight last tested? (Date) and what was the result
*
Hearing
Please state if your child has had, or is suspected of suffering from any ear or hearing trouble e.g. discharge from ear, ear operations, grommet insertion/remove, adenoidectomy, tonsillectomy, severe ear infections, deafness. If so please give details below
*
Yes
No
Details
Please state if your child has had any hospital treatment or operations or any series injuries at any time. Are there any areas concerning your child's health that you feel particularly concerned about or would like to discuss with the School Nurse, if so please give details below
*
Yes
No
Details
Has the fourth (pre-school)vaccine been given for
*
Diptheria
Poliomyelitis
Measles
Whooping Cough
Tetanus
Rubella (German Measles)
None of the above
Is your child on any treatment, either continuously or from time to time? (Please give details below)
*
Yes
No
Has your child suffered from an allergic reaction or had any serious adverse reaction to any medication? (Please give details below)
*
Yes
No
Has your child suffered from any accidents or serious emotional shocks? (Please give details below)
*
Yes
No
Are there any difficulties in reading and writing? (Please give details below)
*
Yes
No
As far as you are aware [for young children] have there been any problems in early childhood or infancy e.g. feeding difficulties, late walking, late talking, poor bowel control, poor bladder control, overactivity? (Please give details below)
*
Yes
No
Please state and give details below if your child has any behavioural issues. (Please give details below)
*
Yes
No
Is there any history of physical or mental illness in the family that you think may have a bearing on your child's health? Please give details below
*
Yes
No
Details of any of the above if ticked yes
Medicine/Homeopathy Consent
I consent for my above-named child to be given the following medication/remedy (as necessary) by the school nurse.
Medicines
*
Ibuprofen/Ibuprofen suspension (Nurofen for children) age dependent
Calpol / Calpol 6+ (age dependent) (paracetamol suspension)
Allergy / hay fever relief (syrup or tablet — age dependent) (non drowsy — cetirizine hydrochloride or loratadine)
Piriton (chlorphenamine maleate) (may cause drowsiness — usually only used if specifically requested)
Anthisan cream (for bites and stings) (mepyramine maleate 2%)
Homeopathic remedies
None of the above
Please attach a headshot photograph of your child
*
Click or drag a file to this area to upload.
Signature
*
Clear Signature
Date
*
Email address of parent completing the form (Once you have pressed submit you will receive a copy of the completed form)
*
Submit
Where Next?
Admissions
Lower School
Reception - Year 6
Upper School
Year 7 - Year 11
Sixth Form
Year 12 - Year 13