Student details

    YesNo

    Prescription medication

    YesNo
    I would like St. Andrew’s staff or the homestay host to administer my child’s medication and give my consent for them to do so.I believe my child is able to administer their own medication and give my consent for them to do so.

    Emergency medical treatment

    YesNo

    Dietary Requirements

    Learning difficulties

    YesNo

    Medical history

    YesNo

    Are you suffering from or have you ever suffered from:

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    Medical history

    Heart and Circulation

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    Respiratory

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    Psychological health

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    Eyesight

    YesNo
    YesNo
    YesNo

    Hearing

    YesNo
    YesNo
    YesNo
    YesNo

    Gastro-intestinal / abdominal

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    Blood / metabolic disorder

    YesNo
    YesNo
    YesNo
    YesNo

    Neurological

    YesNo
    YesNo
    YesNo
    YesNo

    General Medical

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo