Page 8 - Hauna Handbook 2022

STUDENT’S COPY
Latest
HEALTH HISTORY FORM Passport
size photograph
Note to Parents: Please fill in the details in this page in school
uniform.

Name : ............................................................................................ Grade : .........................Sec: ..................
Father / Guardian’s Name :...................................................... Mother’s Name :.............................................

Emergency phone number (to reach parents): ................................................................................................

Physician to be called in emergency:................................................................................................................
Address: .........................................................................................................................................................

Telephone No.............................................................................Mobile No: ...................................................
Neighbour, friend or relative to be called in emergency or illness:

Address:..........................................................................................................................................................

........................................................................................................................................................................
Telephone No :............................................... Mobile No.:..............................................................................

Has the child ever suffered from the following? If so, when?
Asthma/Allergies/Diabetes/Epilepsy/Heart/Disease/Ophthalmic/Defect/Auditory defect/hearing loss

........................................................................................................................................................................

Is the child on any medication? Yes/No. If yes, please give details

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Blood group of the child:...........................

Does your child wear glasses? Yes/No.
Does your child wear them at all times or only for classwork?...........................................

Is there anything concerning the health of your child which the school should know in order to provide special care?
(Include things such as allergies to insects, food or medicine)

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