Medical Information – Volunteer Student Leader

M1 Student Leader Medical Details
Volunteer Student Leader Applicant - Medical Details Form
Student Leader Name
Student Leader Name
First Name
Family Name
Is the student registered with a Doctor in the UK?
Special Dietary Requirements or Disorders
Has the student experienced any of the conditions mentioned below? (Please tick all boxes that apply.)

Please provide details of all regular medication taken by the student. Please note that ALL medication brought to the School MUST be shown to your child's House Parent.

Please provide details of your child's Tetanus immunisation history.

Medication is administered ONLY when strictly necessary and by qualified nurses or senior staff. These medications can be obtained from a pharmacy in the UK without requiring a prescription. If there are any medications from the following which cannot be given to your child, please advise
PAIN RELIEF: Paracetamol
PAIN RELIEF: Ibuprofen
ANTIHISTAMINE: (e.g. Chlorpheniramine, Cetirizine)

Consent and Signature

I understand that, in an emergency, every effort will be made to obtain my consent prior to an operation and/or the administration of an anaesthetic.
However, should the school be unable to contact me, I hereby give my authorisation for the Director or Deputy Director to consent on my behalf.
Please confirm that you agree to Gordonstoun International Summer School retaining this personal data in compliance with the School's current GDPR policy,
and that we may use this information as necessary to process this application.
Please confirm that you have read, understood and agree to to the Gordonstoun International Summer School Terms and Conditions.
I hereby certify that I have given, to the best of my knowledge, full and correct information about my child's physical & psychological health.
Name of Parent/Guardian completing this form
Name of Parent/Guardian completing this form