Stepping stones pre-school

Health Form

To assist us in providing the best possible care for your child, please complete this form carefully. Please note that
this information will be kept in your child’s file and will be accessible to Stepping Stones staff only.
Type or print clearly in CAPITAL LETTERS

Child’s Details

Child’s Name
Clinic/Doctor’s Name
Date of Birth
Telephone Number

Immunisation Details (copy of vaccination record required)

Polio/OPV Hepatitis
Diphtheria Diphtheria
Petussis
Measles)

Child’s Health Information
Does your child have any allergies?
If yes, please provide details:-


Is your child on any regular medication?
If yes, please provide details:-


Does your child have any speech, vision or respiratory Yes 
problems or any other health condition?

If yes, please provide details:-


Additional Information
Does your child require special educational needs Yes 
support?

If yes, please provide details:-
Stepping Stones is happy to accept children with mild
special needs upon receipt of a full medical report
and assessment prior to registration. Should the report
suggest additional support then a qualified shadow
teacher, approved by us, should be appointed prior to
the child attending the nursery (costs to be paid by
parents). (Domestic helpers/nannies would not be
accepted as a substitute).

Medicine/Medical Treatment Authorisation

I give permission for the following medication to be Paracetamol (or similar non- Yes 
given to my child as needed
aspirin pain reliever)


First aid medication for minor Yes 
wounds/insect bites

I give Stepping Stones permission that in the event of
an accident or an illness requiring immediate medical Yes 
attention, to take my child to the nearest hospital


Declaration Details
I confirm that the information provided is accurate and acknowledge that should I have withheld any information
then Stepping Stones reserve the right to withdraw my child from it’s programme

Parent’s Name(s)
………………………………………………………………………………………………………. Parents’ Signature(s)
………………………………………………………………………………………………………. ………………………….…………………………………………………………………………….

Source: http://steppingstones.ae/download/health_form_edit3.pdf