Secondary School Exchange scholarship 3. Medical form To be completed by the parent(s)/guardian(s) This form provides the schools with full medical information to enable them to watch the scholar’s health for the duration of his/her stay overseas. Please note that a further medical form will need to be completed by the applicant’s GP if the applicant is successful in being awarded a scholarship.
Name:
Date of birth:
Name of parent(s)/guardian(s): Address:
Home tel: Height:
Work tel: m
cm
Weight:
Have the scholar's tonsils and/or adenoids been removed:
kg
Yes/No
If so, when?
Are there any details you feel a school should know about your son’s/daughter's diet, wellbeing, medical history or current condition?
Please tick the boxes as applicable: