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IN SCHOOL STUDENT RECORDS

Please check and confirm that our records are accurate and up to date

TO BE COMPLETED BY FULL-TIME, PART-TIME AND ONLINE STUDENTS WHO ATTEND IN PERSON SESSIONS AT THE SCHOOL (INCLUDING AFTER SCHOOL OR WEEKENDS)

Your Details

First Name

Last Name

Email

Mobile

Student 1

PERSONAL INFORMATION
It is critical that we have all current details for each student. If any personal details have changed you are required by the Ministry of Education to let us know as soon as possible.
Please ensure the details are correct, including phone numbers and email for the Emergency Contacts.
MEDICAL RECORDS AND MEDICINE AT SCHOOL
Please disclose all medical information that may impact on the student's learning or behavior in school.
Ensure you provide details of ALL medication as well as the requirements around dosage etc.
Where applicable, if you would like us to adminster their medication please state your consent on this form. All medicine will need to be label with their name, DOB, and expiry date.
DIETARY AND ALLERGIES
Please disclose full details of all dietary requirements, allergies or conditions.
ED PSYCH REPORTS
If you have an Ed Psych Report please email this to Pip Block at office@a1student.com

First Name

Last Name

Date of Birth

Previous School

Describe the Student's learning challenges?

Medical records & Medicines

Consent to Administer Medicine [if applicable]

Emergency Contact Details

[we need two contacts, one can be the same as the primary contact above]

First Emergency Contact

First Name

Last Name

Email

Mobile

Second Emergency Contact

First Name

Last Name

Email

Mobile

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