T: +971 (0)4 344 6931

F: +971 (0)4 344 6754

E: info@jbschool.ae
Jumeira 1, on 53B Street, off Al Wasl Road
PO Box 211829, Dubai, United Arab Emirates
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Medical and Immunisation Record
and
Consent Declaration
Condential
Please insert
students photo
here.
Childs Name: _________________________________________
Please complete this form and return it to JBS prior to your child starting school.
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Compulsory on Acceptance
The information provided will be treated as condential by all JBS staff. If you have any queries, please feel free to
contact our Nurse, who will be happy to answer any questions.
Name of Child ____________________________________________________ Class ________________________________
Nationality _________________________________ Date of Birth _______________________ Gender M F
Fathers Name _____________________________________ Mothers Name ______________________________________
Fathers Mobile ____________________________________ Mothers Mobile ______________________________________
Physical Address ________________________________________________________________________________________
___________________________________________________ Home Telephone ____________________________________
Alternative Emergency Number(s)__________________________________________________________________________
Contact Person(s) ________________________________________________________________________________________
Please complete the following and tick Yes or No where applicable:
Illnesses Yes No Conditions Yes No
Please provide details for any of the above answered with Yes, inclduing treatment and regular medications
(continue on a separate sheet if required):
Family History
Diabetes Hypertension Stroke Tuberculosis Other ________________________________________
History of: Blood Transfusion No Yes, Frequency ________________________________________________
Hospitalisation No Yes, Frequency ________________________________________________

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Compulsory on Acceptance
Please ensure all consents are signed and dated.
Parental Consent
As the parent/guardian of ________________________________________________ (please print the childs name) I give
consent to the following:
1. Consent for the administration of an over-the-counter medication
In the event that your child develops a fever or has pain it may be necessary to administer an over-the-counter
medication. If your child is unable to take certain medications, please contact the school nurse to advise her so
alternatives can be provided.
I consent to my child being given an over-the-counter medication such as Paracetamol or Neurofen should it be
considered necessary by the School Nurse.
Parents Name (please print) _____________________________________________________________________________
Signature _______________________________________________________ Date ______________________________
2. Consent for emergency treatment
In the event that your child requires emergency treamtment you will be contacted and asked to collect your child
from the school. If the school is unable to contact you, your child will be taken to a doctor/hospital for diagnosis
and treatment. Efforts to contact you will continue.
I consent to my child being taken to a doctor/hospital in the event of a medical emergency.
Parents Name (please print) _____________________________________________________________________________
Signature _______________________________________________________ Date ______________________________
3. Consent for medical examination
According to school health guidelines children require a school physical at certain phase stages in their life (KG1,
G1, G5, G9 and school leavers) and any child new to the Dubai School System.
This service is currently offered to you by JBS, however, if you wish to have your child examined by your own
family GP you may do so at your convenience. The school will require a copy of the doctors report for your
childs health records. JBS has its own school doctor.
We would also like to reassure parents that the safety and wellbeing of the children are of prime importance to
us and they are supervised at all times during the examination by the School Nurse.
As parents you will be notied prior to any examination taking place and will be given the opportunity to attend.
I consent to my child having a school physical.
Parents Name (please print) _____________________________________________________________________________
Signature _______________________________________________________ Date ______________________________
Please note that all consents are valid for the period of time your child is attending JBS.
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Compulsory On Admission
Immunisation History
The Department of School Health requires that the school maintains current information on each childs
immunisation history. It is therefore important that Jumeira Baccalaureate School has a copy of your childs
immunisation records.
JBS does not have an immunisation programme. Please make an appointment with your family GP for any
required immunisations.
(Please tick the appropriate box)
I have attached a copy of my childs immunisation records
I will bring a copy to the nurses clinic as soon as possible
Previous Dubai School
Please complete below if your child previously attended another school in Dubai.
Name of previous school ________________________________________________________________________________
We have the school health booklet in our possession and will bring it to the nurses clinic
As far as we aware the previous school still has the health booklet