Dietary, Medical & Asthma Info Check September 2024

27th June 2024

Dear Families,

Dietary, Medical & Asthma Information Check

Thank you for the health information you have provided for your child via our Admission Form or Edulink One. Please could you just provide us with a bit more detail to ensure that we can support your child appropriately.

You only need to answer the questions that are relevant.

Children with Asthma: Please hand an inhaler and spacer in a named clear container to your child's class teacher on your child's first day.

Kind regards

The Dunalley School Team

1. YOUR CHILD

Legal Forename:
Legal Surname:

2. Pupil details:

My child has a dietary requirement (DO NOT ANSWER - PLEASE LOG ONTO EDULINK ONE AND CHECK / UPDATE)
My child has a medical need (go to question 5)
My child has asthma (go to question 5)
My child no longer has a dietary, medical or asthma need (give details below and go to question 12)

Please give details of the dietary, medical or asthma need they NO LONGER have

3. Is the Dietary Need: (DO NOT ANSWER - PLEASE LOG ONTO EDULINK ONE AND CHECK / UPDATE)

Medically Certified Allergy / Condition - Please supply evidence
An Intolerance
Life Choice
Religious Observation

4. Please identify the food to be avoided / dietary need: (DO NOT ANSWER - PLEASE LOG ONTO EDULINK ONE AND CHECK / UPDATE)

Please give full details of Dietary Need:

5. Is the Medical Need:

Please give full details of Medical Need:

6. Asthma

	Please select
Diagnosis	Diagnosis Please select

7. Inhalers in School

	Storage
Inhaler in School	Inhaler in School Storage

8. My child has a working, in-date inhaler, spacer if required, clearly labelled with their name at school in their classroom

	Inhaler 1	Inhaler 2
Name of Medication	Name of Medication Inhaler 1	Name of Medication Inhaler 2
Dose	Dose Inhaler 1	Dose Inhaler 2
Method of Administration	Method of Administration Inhaler 1	Method of Administration Inhaler 2
When taken	When taken Inhaler 1	When taken Inhaler 2
Side effects	Side effects Inhaler 1	Side effects Inhaler 2
Expiry Date	Expiry Date Inhaler 1	Expiry Date Inhaler 2

9. In the event of my child displaying symptoms of asthma and their inhaler is not available or is unusable, I consent for them to receive Salbutamol from the emergency inhaler held in school.

10. Inhaler Administration

	Please select
How is the inhaler to be administered	How is the inhaler to be administered Please select

Additional Information about your child's asthma::

11. I certify that all the information I have given about my child's is correct.

Parent / Carer Name
Relationship
Signed