The Doon Girls School Name Date of Birth : ..cecssseenseseseneesee Medical Record Update House/Roll number # occ The Doon Girls School tries to provide the best possible care for its students while they are at school. Please assist us in keeping your daughter safe by providing full and accurate information about her health during the holidays so that we may keep our records current. Yes No Did your daughter have any illness while on holiday? Is your daughter suffering from any infectious disease at present? Has there been any change in her health status while on holiday? oO oO Has she been given any vaccinations while on holiday? oO oO Has she been started on any long-term medication?’ Has she started having periods? Has any family member had typhoid or hepatitis in the last three months? during the last three months? Was there an illness or death in the famil Oo oO Please give details if you have answered any of these questions in the affirmative. If your daughter had an illness for which she needed to see a doctor, or had any investigations done, please attach copies of relevant records. Was there a major change in family circumstances’ in the last three month: If there is anything NEW about your child that you would like us to know please tell us in the box below. 1. Includes having been prescribed glasses, contact lenses, ot other aids and appliances. 2. Including a move, separation or divorce. PLEASE complete this form and return it to the school BEFOREThe Doon Girls School Name Date of Birth : ..cecssseenseseseneesee Medical Record Update House/Roll number # occ I declare that my daughter/ ward is not suffering from any illness that would constitute a risk to himself or to others while she is at school, and that the Information I have given in this form is complete and accurate to the best of my knowledge and belief Name Signature Relationship (specify mother, father or legal guardian) Date