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Medical Form 2026
Summer School 2026 Medical Form
Please fill this form as accurately as you can, and return it as soon as possible – especially if your young person has any significant needs. Also, please note that any medication MUST be handed in with an up to date list of medication before the young person gets on the coach or is dropped off at the event. This includes medications that may seem harmless, such as antihistamines or other over the counter medicines.
Full Name
First
Last
Date of Birth
MM slash DD slash YYYY
Age at Summer School
NHS Number
Date of last Anti-Tetanus Vaccination
MM slash DD slash YYYY
Name and Address of GP
Phone Number of GP
Please tell us about any medical conditions we need to be aware of, including any allergies and their severity.
What (if any) medication do they take for the medical conditions/ allergies mentioned above? Please include if they need to keep this medication with them at all times.
Please list any other medications they will be bringing to summer school.This should include pain relief medications such as paracetamol and/or ibuprofen if they will be bringing it.
Please tell us about any dietary requirements.
Does your young person have any sensory needs that we might need to know about? If so, can you give us some details?
Is there anything else you think it would be useful for us to be aware of? Alternatively, would you like someone to contact you to talk about anything?
Permissions 1 – We will always attempt to contact the parents/ guardians of a young person if they need to see a doctor. However, if a doctor thinks medical treatment is required:
I give permission for Penicillin to be used
Yes
No
I give permission for other antibiotics to be used
Yes
No
I give permission for a blood transfusion
Yes
No
I give permission for X-Rays
Yes
No
I give permission for anaesthetics to be used
Yes
No
Permissions 2 – Do you agree to the medical coordinator at Summer School administering the following over-the-counter medications to your young person if it is necessary?
I give permission for paracetamol to be used
Yes
No
I give permission for ibuprofen to be used
Yes
No
I give permission for antihistamines to be used
Yes
No
Sleeping Arrangements
At Summer School, we provide a ‘gender inclusive’ dorm for young people who do not identify as their birth gender, or those who are more comfortable sleeping in a mixed dormitory. All of the rooms at our venues have more than two beds, so no young people will be sleeping in a room with just one other young person, no matter the dormitory they are in. I give permission for my young person to sleep in a gender inclusive dorm.
Yes
No
Travel Arrangements
This year, the coach pick ups will be at Lymm Services and Crewe Train Station. You've already indicated whether you're young person will be getting on the coach on the application form, but to ensure we have an up to date list please indicate which travel arrangement you'll be using below. Also, if this changes for any reason please let us know as soon as possible! My young person will get the coach from –
Lymm Services
Crewe
They will not be using the coach
Declarations & Signatures
Consent
(Required)
I will let you know if my young person comes into contact with any infectious illnesses in the three weeks before Summer School.
Consent
(Required)
I confirm that all the information given on this form was correct at the time of submission
Parent/Guardian Signature
(Required)
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