Evolution Education – Student Medical Information & Consent Form

Why we collect this: To safeguard students and staff and ensure appropriate medical care. Data is processed under UK GDPR/DPA 2018 for vital interests/education. Please update us immediately if details change.

Student Details

Home address

NHS number (if known)

Optional but helpful for emergency services.

Parent/Carer & Emergency Contacts

Primary parent/carer name

Relationship

Phone

Second emergency contact name

Relationship

Phone

GP & Medical Practice

Medical Conditions

Asthma Action

Reliever inhaler type/colour

Spacer used?

Known triggers

Emergency steps (if wheezy/asthma attack)

Severe Allergy / Anaphylaxis

Allergen(s)

Typical symptoms

Adrenaline auto-injector brand

Emergency steps (anaphylaxis plan)

Diabetes

Type

Insulin/medication regimen

Hypo treatment available onsite?

Hypo/hyper emergency steps

Epilepsy / Seizure Management

Seizure type

Medication

Rescue meds prescribed?

Emergency steps

ADHD/ASD/Neurodiversity

Strategies that help

Other Long-term Condition

Name of condition & key info

Medications & Allergies

Current medications (name, dose, time)

Allergies (food/medication/other) & reaction

Emergency Medication Onsite

Emergency meds kept onsite?

Where stored

Expiry date(s)

Dietary Requirements

Consent

I consent to trained staff providing first aid and contacting emergency services if required. I authorise staff to administer the medications I have supplied as written above/care plan. I consent to relevant medical information being shared with staff, first aiders, and emergency services for safeguarding. I consent to first aid being provided on off-site activities and sports fixtures.

If you have a clinician-issued care plan (e.g., anaphylaxis, asthma, epilepsy, diabetes), please email it to admin@evolution-sportsgroup.com and lgavillet@evolution-sportsgroup.com so we can attach it to the student record.

Signatures

Tip: “Generate Signed Preview” converts fields to static text so everything appears cleanly in print/PDF.