Illness during the Holidays:
Electronic form

Pupil's Name:
House (Please select):	Please select Pringle Pringle III Chalmers West Chalmers East Rogerson East Rogerson West Evans
Details of Illness: Please indicate if treatment was received in hospital or through visit to General Practitioner /Family Doctor
Treatment or Medication given: please give exact dosage and indicate when a repeat prescription may be required if relevant.
Has your son been in contact with any infectious diseases during the holidays? If so, please give details:
When did they last visit the dentist?
Your Email address
Pressing send will deliver this form to the School Medical Centre.