Your child's heath and well-being is of great importance to us

STUDENT'S HEALTH HISTORY (To be filled out by Parents) . Your child's health and well-being is of great importance to us. Please complete this form carefully in order to assist us support child. First Name: Middle : Last Sibling at AIS: Name & Grade:
Name of Emergency Contact in Muscat (other than yourself) Telephone #
STUDENT'S HEALTH HISTORY

Does your child have any of the following? If yes, please give details such as specific and current treatment.
For allergies, specify allergens and note severity of the allergies.
1. Allergies: Food/ Medicine/ Environmental 3. Attention Deficit Disorder/ Hyperactive Please describe any past or present serious illness, fractures, physical or emotional problems. .
.
. Is your child on any regular medication? If so, please list: .
. Designed by Vancouver Offshore Schools Group. All rights reserved. REQUIRED IMMUNIZATIONS:

Please indicate below if your child has received the following immunizations. Fill in dates if available.
Photocopies of records are acceptable.
DPT:

PERMISSION FOR MEDICATION:
AIS has my permission to give my child the following medications if necessary (in age appropriate doses):
Paracetamol, (Panadol, Tylenol, Ibuprofen, or similar non-aspirin pain reliever)
Cough syrups (expectorants, decongestants. suppressants, antipyretics) First aid medication for minor wounds or insect bites
ANY MEDICATION TO BE GIVEN AT SCHOOL MUST BE HANDED IN TO THE SCHOOL OFFICE BY A
RESPONSIBLE ADULT. INSTRUCTIONS INCLUDING DOSAGE AND TIME OF ADMINISTRATION
AND PARENT SIGNATURE MUST BE INCLUDED. LONG-TERM MEDICATION MUST BE
ACCOMPANIED BY A NOTE FROM CHILD'S DOCTOR.
I hereby give permission for emergency measures to be initiated in case of accident or sudden illness with the
understanding that I will be notified as soon as possible.
I also understand that AIS or their designees cannot be held liable for their actions while performing their duties
in a responsible manner.
I accept full financial responsibility for any medical cost incurred by the school for my child.

WE ENCOURAGE YOU TO LEAVE A DOSAGE OF ANY ROUTINE OR EMERGENCY MEDICATIONS
(inhalers, EpiPens, etc.) in the school office, clearly marked with your child's name and grade. Please provide us
with all health information in case your child has either an acute or chronic condition or contagious disease.
Because we wish to provide your child with the safest and healthiest environment, children who have fever and
infectious diseases cannot attend school.
We will be happy to assist you with any questions or concerns.

Note: This record must be completed and kept on file in the Nurse's office on or before the date the student
enter school.

Designed by Vancouver Offshore Schools Group. All rights reserved.

Source: http://ais.edu.om/uploads/health-form-eng.pdf

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