Child Medical and Allergy Form

Who this is for

The one-page form a school, club, sitter or relative is handed. Everything on it is written by the parent: who to ring, who the doctor is, what the child has been diagnosed with or reacts to, and what the family has been told to do about it — in the parent's own words, not ours.

Parents filling in the same details for the fourth time this term, clubs, sitters and settings who need something signed and dated on file, and anyone leaving a child with a relative for a few days.

What this helps you track

• Who to ring first, second and after that, with numbers
• The doctor's practice and any hospital or specialist the family names
• Conditions and allergies as the parent states them
• What the parent has been told to do, written down in their own words
• Consent lines, a signature and a date, so the form is current rather than vague

How to use it

1. Fill in the child's details and the contacts in order, with a number that will actually be answered against each.
2. Write the doctor's practice and phone number, and any other professional the person holding this form may need to name.
3. List each condition or allergy on its own line, with how it shows itself described plainly.
4. In the what-we-do column, write the instruction your own doctor or nurse gave you, in their words — nothing on this sheet tells anyone what to do, and it should not.
5. Go through the consent lines and tick only the ones you agree to; strike through anything you do not.
6. Sign and date it, hand over a copy, and fill in a fresh one whenever anything changes rather than amending an old one.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Does this form tell the school what to do in an emergency?

Only in your words. Every instruction on it is one you have written down from what your own doctor, nurse or pharmacist told you. We supply no medical guidance, no doses and no procedures, and you should not treat the form as a care plan unless a professional has written one for you.

Will a school or club accept this instead of their own form?

Some will and some will not — most settings have paperwork they are obliged to use. This is useful either way, because it gathers everything in one place so filling theirs in takes five minutes instead of a week of trying to remember.

How often should it be replaced?

Whenever something changes, and whenever whoever holds it asks for a current one. The date and signature at the foot are what make it worth anything; an undated form tells the reader nothing about how true it still is.

What about medicines held at the setting?

Name them here so the reader knows they exist, and use whatever separate signed permission and administration record the setting keeps. This form deliberately has no dose column.

Is a photograph a good idea?

Many settings ask for one. There is a box for it in the fillable version, and on paper a photo clipped to the sheet does the same job.