MARINA(JBR) BR.MEADOWS BR.POLO BR.

04 454 840404 551 6335

04 424 379104 422 422204 368 9882

LAKES BR.ALFURJAN BR.

JEBEL ALI VILLAGE NURSERY LLCEstablished since 1976

P.O. Box 53951 , Duba i , U .A .E ., Te l : +971 4 4243791 / 2 , Fax : +971 4 4243790E - M a i l : i n f o @ j e b e l a l i n u r s e r y . c o m W e b s i t e : w w w . j e b e l a l i n u r s e r y . c o m

MEDICAL FORM

P 1

Name of Child ………………………………………………………………....... Date of Birth …………………………………………………….….

Home telephone number ………………………………………………….. Office number...........................................................

Mother’s Mobile .................................................................... Father’s Mobile ........................................................

Emergency number (other than parents) ……………………………..................... /...........................................................

Family Doctor ……………………………………………………………………. Clinic …………………………………………………….………………

Dear parents,

The Department of Health requires that all nurseries maintain a record of each child’s medical history. Therefore, we would appreciate if you could complete the following and return it to

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No

No

No

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Yes

Yes

Heart Disease

Epilepsy

G6PD

Asthma

Tuberculosis

Pneumonia

If your child suffers from any allergies

MARINA(JBR) BR.MEADOWS BR.POLO BR.

04 454 840404 551 6335

04 424 379104 422 422204 368 9882

LAKES BR.ALFURJAN BR.

JEBEL ALI VILLAGE NURSERY LLCEstablished since 1976

P.O. Box 53951 , Duba i , U .A .E ., Te l : +971 4 4243791 / 2 , Fax : +971 4 4243790E - M a i l : i n f o @ j e b e l a l i n u r s e r y . c o m W e b s i t e : w w w . j e b e l a l i n u r s e r y . c o m

MEDICAL FORM

P 2

In order to reduce the spread of illnesses in the Nursery, the following regulatons apply:

1. Please send your child to the Nursery if they have any of the following:

● Fever (more than 37.5°C or 99.5°F)

●

●

● Diarrhoea (not to return to the nursery for 24 hours the last diarrhoea episode)

● A heavy nasal discharge (watery or yellow or green)

● A sore throat, throat pain

● A persistent cough

● Red, watery and painful eyes, yellow or green discharge from the eyes

● Ear Ache

2. If they have an infected wound, it must be covered well with a dressing or plaster.

3. other children and staff, you will be contacted to collect him/her from Nursery on urgent basis.

4. If your child has suffered from a contagious illness, we require you to submit a MEDICAL CERTIFICATE from your GP that states that your child is NO LONGER CONTAGIOUS before coming back to the Nursery.

5. to your child’s health that you feel we might need to know.

I have read, understood and agree to abide by the terms and conditions as outlined above.

Parents Signature: …………………………………………….…… Date:……………….………..……………………….

Name of Child:………………………………………………………..

DO NOT