Medical Form

Step 1 of 6 - Dear Parent

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This form MUST be completed in English.
Medical contract with parent
It is a necessary requirement for enrolment at Buckswood School that you complete and submit a medical form in respect of your child. You must inform the School of any health or medical condition, special educational need(s), disability or allergy that your child has or subsequently develops, whether long-term or short-term, including any infections. You must also provide us, whether upon further request by the School or otherwise, any reports or other materials relevant to any of the same.

For safety, students are not allowed their own supply of medicines. The exception to that, is those students who have a diagnosed medical condition. In such cases we must receive a doctor’s letter with the medical diagnosis and a written prescription. This must be in English with a date on it and include the:
- Name of your child
- Name of the medication
- Dose
- Time the medication is given
- Length of course
- Side Effects
- Contra-indications (e.g. any other medication/treatment that shouldn’t be given at the same time).
At Buckswood, we have students with many different medical and emotional conditions. These can usually be well managed with treatment and or medication. There is no difficulty with students continuing with their medication whilst at school. However, we MUST have the required information. There are strict guidelines in the UK about how medication is administered, and any medication that is supplied, should be in its original packaging. We will therefore assess each student on an individual basis. This may include an appointment with a doctor to get their approval for certain medication. Some may be permitted to administer their medication themselves but the majority will be given their medication by a member of staff.

Any medication and/or supplements brought to the school without that information, will not be permitted. If students break this school rule, they are at risk of a fixed term exclusion.

By signing this contract you are agreeing to suitably qualified school and NHS staff giving appropriate medicines, medical treatment and First Aid in accordance to the school’s Administration and Management of Medicines policy.

Details, such as medical information and health records, about my child may need to be shared with other staff and external agencies, such as GPs and opticians, if we believe it is in their best interests. The School will collect and process personal information relating to students in accordance with our privacy notice which can be found on our website at Privacy Notice. This is within compliance of the GDPR which came into force on 25th May 2018.
I have read and understand the Parent Medical Contract above*
- Yes, i understand
Name of Student*
Start Date*
Date Format: DD slash MM slash YYYY
Parent/Guardian Name*
Parent/Guardian Email Address*
Date*
Your Admissions Representative at Buckswood*
- Samantha Pugh (UK Admissions)
- Olga Nalivkina (International Admissions)
- Cristina Terrazas (International Admissions)
- Yu Hao (Phoenix) (International Admissions)
- Kyoko Field (International Admissions)
- Sherene Zouehid (International Admissions)
- Unsure of the representative in charge
If you have any questions, please feel free to contact us:

Buckswood Health Service (BHS) Nurses: Louise McCarthy and Maxine Garry, Administrator: Nicole Trevett

Phone: 01424 813813 – Ext 251,Email: nurses@buckswood.co.uk

Medical contract with Student
Welcome to Buckswood School. We look forward to meeting you. During your first term you will be invited to attend a New Student Health Check where you will meet the health team and discuss any health needs. If there is anything you are worried about, please come and talk to us as for many of you, this will be your first time away from home.

At Buckswood, we have students with many different medical and emotional conditions. These can usually be well managed with treatment and or medication. There is no difficulty with students continuing with their medication whilst at school. However, we MUST have the required information. We will contact your parents for this additional information. You will not be allowed to keep medicines in your room unless it has been agreed by the nursing staff.

If you are unwell please come and visit us at BHS (Buckswood Health Service) or speak to your house staff. We are open from 7.30am until 8.30pm Monday – Friday. You can visit us before or after lessons or, during your breaks. You will be allowed to see a nurse during lessons if you have permission from your teacher first. The nurses, health care assistants and school counsellor are all based at BHS.

By signing this contract you are agreeing to suitably qualified school and NHS staff giving appropriate medicines, medical treatment and First Aid in accordance to the school’s Administration and Management of Medicines policy.

Details, such as your medical form and health information, may need to be shared with other staff and external agencies, such as GPs and opticians, if we believe it is in your best interests. The School will collect and process personal information relating to students in accordance with our privacy notice which can be found on our website at Privacy Policy This is within compliance of the GDPR which came into force on the 25th May 2018.
I have read and understand the Student Medical Contract above*
- Yes, i understand
Name*
Date*
If you have any questions, please feel free to contact us or come in to BHS during one of your breaks:

Buckswood Health Service (BHS) Nurses: Louise McCarthy and Maxine Garry, Administrator: Nicole Trevett

Phone: 01424 813813 – Ext 251,Email: nurses@buckswood.co.uk

Student First Name*
Student Surname*
Gender*
Address*
Date of Birth*
Place of Birth*
Nationality*
Parents Email Address'*
Educational Agent Email Address

Your child’s health and welfare is of paramount importance to us. In order to ensure their well-being whilst at Buckswood School, all boarding students who are staying at the school for 6 months or longer will be registered with the local NHS doctor. Students who are not from the EEA and are at Buckswood School for less than 6 months and have not paid the health surcharge as part of their visa will need to obtain health insurance prior to their arrival in the UK to enable them to access health care through the NHS.
Has he/she ever lived in the UK? If so, where?*
If yes, what was the name and address of their GP?
Does he/she have any of the following conditions if so, please include further details including date of diagnosis and any treatment or medication prescribed?
Asthma*
ADHD/ADD*
Diabetes*
Epilepsy*
Autism*
Hayfever*
Dyslexia*
Hearing/ Sight difficulties*
Please give dates of the last routine dental and vision checks (It is advised that students keep up with their routine dental and visions checks during the school holidays.) If glasses or contact lenses are worn, please also send a copy of their vision prescription.
Other Medical Conditions:*
Does your child have any allergies? (please give details)*
Has he/she ever been admitted to hospital? (Please give details)*
Does your child require a special diet?
If your child needs any medication, we will provide it. Please do not send your child with any medication unless it has been prescribed by a doctor, they will not be permitted to use it.
Please give details of any medically prescribed medication (name, reason for using it and dose).*
Please give dates of the last routine dental and vision checks (It is advised that students keep up with their routine dental and vision checks during the school holidays.) If glasses or contact lenses are worn, please send a copy of their vision prescription.
Date of last Dental check
Date Format: MM slash DD slash YYYY
Date of last Vision check
Date Format: MM slash DD slash YYYY
Is there anything else we should know about to help your child whilst we are looking after them e.g. family bereavements, emotional problems.
The above information is correct**
- Yes, i understand
Name*
First Last
Date*
Date Format: MM slash DD slash YYYY

Students staying 6 months or longer are registered with a UK GP, are eligible to have a Diphtheria, Tetanus and Polio booster and Meningitis ACWY vaccination during Year 3 at Buckswood. In addition girls in Year 2 will be offered the HPV vaccination (2 doses) you may opt in or out of these.

Please mark any inapplicable fields as "N/A"

Please be aware that any student residing in the UK should be vaccinated in line with the UK vaccination schedule

Please provide dates for the following UK required Vaccinations

The following Vaccines require evidence of 5 doses (If over 14yrs old) or evidence of 4 doses (If 13yrs and younger)
Diphtheria (Vaccinations)*
Tetanus (Vaccinations)*
Polio (Vaccinations)*
The following require evidence of 2 doses
Measles (Vaccinations)*
Mumps (Vaccinations)*
Rubella (Vaccinations)*
Meningitis C or ACWY (Vaccinations)*
HPV evidence of 2 doses of 13 years (girls only)*
Please provide details of other vaccines
Chicken Pox (Varicella) (Vaccinations)*
Hepatitis A (Vaccinations)*
Hepatitis B (Vaccinations)*
Typhoid (Vaccinations)*
Yellow Fever (Vaccinations)*
Rabies (Vaccinations)*
Before a visa can be issued in some countries, you must provide proof of immunity to TB. The link with more details is: https://www.gov.uk/tb-test-visa/countries-where-you-need-a-tb-test-to-enter-the-uk
BCG- Tuberculosis (Vaccinations)*
Tuberculosis Skin Test*
Please give details of any other vaccinations.*

To access the NHS you will need to provide evidence of one of the following (please bring this with you on your arrival at Buckswood School):
Does your child have an EHIC?
- Yes
- No
Has your child paid the Health Surcharge as part of their visa?
- Yes
- No
Have you arranged medical insurance for the entire stay?
- Yes
- No
I agree to suitably qualified school and NHS staff giving appropriate medical treatment and First Aid.*
- I agree
Is there anything else we should know about to help your child whilst we are looking after them e.g. family bereavements, emotional problems.*
I confirm that the above information is true, to the best of my knowledge
Parent/ Guardian Name*
Relationship to student*
Date*
Please use the pen tool to sign in the box below
Signature*
Consent*
I agree to the privacy policy.
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