MEASLES VACCINATION REGISTRATION FOR STUDENTS AGED 6 - 10 AT SCHOOL - The Western Australian International School System

Student Full Name *

Age Level *

Parent Full Name *

Phone Number *

Registration for Measles vaccination for students at school *

Health condition of students

Has your child received any vaccinations in the past month? *

If yes, please specify. *

Is your child allergic to any medications, vaccines, or foods? *

Name specify. month?

If yes, please specify. *

Is your child currently sick or running a fever? *

Does your child have any chronic medical conditions (e.g., heart disease, blood disorders, etc.)? *

If yes, please specify. *

Has your child taken any medications in the past two weeks? *

If yes, please specify. *

Checkboxes *

I confirm that the personal information provided is accurate and consent to the School collecting, storing, processing, and using it in accordance with personal data protection laws for the purpose of admission consultation.