• Child's Health Care Plan

  • How to complete this form

  • Please complete a separate form for each medical condition, allergy, or intolerance. This helps us respond appropriately to each individual need, ensure the correct emergency procedures and medication plans are in place, and make any necessary reasonable adjustments.

    If your child has multiple medical conditions, please submit a separate form for each

  • Today's date
     - -
    2 digit day, 2 digit month, 4 digit year
  • Expiry date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Your child's DOB*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Why are you completing this Health Care Plan?*
  • When was this first identified? Please put an approximate date if you are unsure*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Has this been diagnosed by a healthcare professional?*
  • Are you in the process of getting this diagnosed by a healthcare professional*
  • Is this condition life-threatening?*
  • Does your child experience any specific symptoms when their condition begins or worsens that staff need to look out for?*
  • Please check any symptoms your child experiences when exposed to the allergen*
  • Does this condition mean your child has any specific dietary requirements or restrictions?*
  • Are there any ways this condition affects your child’s ability to take part in nursery activities or daily routines?*
  • Do you think the nursery requires any specific training to properly support your child due to this condition?*
  • Are there any specific situations or triggers that worsen your child’s condition? (e.g., exercise or flashing lights)*
  • Are there any specific situations, triggers, or environments that worsen your allergy or increase the likelihood of a reaction? (e.g., certain weather conditions or exercise)*
  • Do you have any medication for this condition that may need to be given at the nursery (e.g., EpiPen)?*
  • Please list any medication required. Click "Add Row" as required for more entries*
  • Does your child take any medication for this condition that does not need to be kept at the nursery?*
  • Please list any medication required. Click "Add Row" as required for more entries*
  • Is your child undergoing any other treatments for their condition?*
  • Are there specific actions the nursery should take in an emergency if your child's condition suddenly worsens?*
  • Is there anything else we need to know?*
  • Should be Empty: