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MODERN HIGH SCHOOL FOR GIRLS

MODERN HIGH SCHOOL FOR GIRLS

Certificate of Health and Fitness

Name of Child
Date of Birth
The following must to be completed by a registered medical practitioner only
Does the applicant receive any regular medication?
If Yes, please mention details
Does she have any known drug allergy?
Does she have any known food allergy?
Does she suffer from any known chronic illness?
Has she had any surgery?
Does she wear spectacles? If yes, please indicate power
Does she use a hearing aid?
Has the standard vaccination schedule been followed?
Has she ever suffered from convulsions?
Has the applicant ever consulted a psychiatrist/ psychologist/or counsellor? if yes please mention the details
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is fit to attend regular school and participate in school and co-curricular activities.
Name of Medical Practitioner
Licence No.
Signature and stamp of Medical Practitioner
It is important to complete this form carefully and honestly as it is for the safety and well-being of your ward. Not disclosing serious medical issues is a risk to your ward. No applicant is discriminated against if she is able to benefit from our school environment.

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