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Staffordshire Special School Nurse Service Consent Form
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Staffordshire Special Needs School Nursing Service
Staffordshire Special School Nurse Service Consent Form
Which school does your child attend?
*
Required
Blackfriars Academy
Chasetown Community School
Cherry Trees Community Special School
Cicely Haughton School
Fountains High School
Fountains Primary School
Greenhall Nursery
Hednesford Valley High School
Horton Lodge Community Special School
Loxley Hall School
Marshlands School
Merryfields School
Newfriars Academy
Queen's Croft High School
Rocklands School
Saxon Hill Academy
Sherbrook Primary School
What is your child's full name
*
Required
What is your child's date of birth?
*
Required
What is your child's NHS Number? (if known)
I give permission for any relevant information regarding my child's health being shared with other professionals or teaching staff.
*
Required
Yes
No
If the school nurse is unable to contact me, I give permission for my child to be seen by the school nurse if a concern is raised at school.
*
Required
Yes
No
I agree to allow health professionals or teaching staff to share relevant information about my child’s health, often by requesting copies of recent clinic appointments or notes from specific consultants or the GP.
*
Required
Yes
No
I give permission for my child's weight and height to be measured.
*
Required
Yes
No
Enter your name (person with parental responsibility)
*
Required
Preferred way for us to contact you
*
Required
Phone
SMS (text)
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Please give us your phone number or email address
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Privacy policy
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I agree to the
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