Please complete this form as accurately as possible and return it to the Admissions Office as part of the application process.
Health informationGeneral Medical History: Please answer all questions.
Does your child suffer from any chronic medical conditions (Asthma, diabetes, epilepsy, etc)? MedicationIs medication taken at home on a daily basis? Is your child receiving current or ongoing treatment for any medical, surgical or psychological condition? Admissions Office · Steinacherstrasse 140 · CH-8820 Wädenswil · T +41 58 750 25 00 · F +41 58 750 25 01 · info@zis.ch · www.zis.ch AllergiesPlease list all allergies your child has including foods, drugs, plants and animals. None Is there any additional health information you feel the school should be aware of? I, the parent or guardian of the above named student, declare that I have answered the questions about his/her health record to the best of my ability and have not withheld any information. I agree to inform the school of any changes in the health status of my child. I also understand that the school does not carry health, accident or liability insurance on its students and that it is my responsibility to provide for such insurance covering Switzerland and abroad. I will not hold the school, or any of its employees, financially responsible or personally liable for the emergency care and/or emergency transportation of my child. I further understand and accept that the school will act within its capacity to provide for the immediate physical well-being of every student during the time he/she is on school premises, or a school sponsored event or trip. In the event of injury, accident or illness, I give permission for my child to receive medical treatment, including surgery, which on the recommendation of qualified medical personnel may be deemed necessary.
Admissions Office · Steinacherstrasse 140 · CH-8820 Wädenswil · T +41 58 750 25 00 · F +41 58 750 25 01 · info@zis.ch · www.zis.ch The physical examination below must be completed by a licensed physician.
Medical History Only for Middle and Upper School Students (Grade 6–12)The above named student is physically capable of participating in competitive sports with no limitations.
Immunization recordPlease supply the most recent dates (month/year) of the immunizations: Admissions Office · Steinacherstrasse 140 · CH-8820 Wädenswil · T +41 58 750 25 00 · F +41 58 750 25 01 · info@zis.ch · www.zis.ch Over the Counter Medication Permission Form The permission form below allows us to give your child non prescription, over the counter medicines if other conservative measures such as rest, ice, heat etc., fail to give your child relief. These medicines might include, eye drops, topical pain relievers, Paracetamol (Panadol) throat lozenges, ibuprofen etc.
The permission form also allows non-medical personnel – faculty, staff and chaperones – to administer this medication on sport or field trips when the nurse in not available. We keep careful records of who receives these medications, why they were administered, and the time they were administered. Please sign the form below and return it with the Health Form Update to your campus school nurse or main office before school starts.
The ZIS Nursing TeamBetsy Zimmermann, Lower School Student Name: ________________________________________ The school nurses or designated faculty, staff or chaperones have my permission to administer over the counter, non prescription medicines to my child as needed.
Parent’s Name: _________________________________________________________________________ Parent signature: _____________________________________________________________________ Any Comment:_________________________________________________________________________ Admissions Office · Steinacherstrasse 140 · CH-8820 Wädenswil · T +41 58 750 25 00 · F +41 58 750 25 01 · info@zis.ch · www.zis.ch

Source: http://www.zis.ch/uploaded/ZIS/Admissions/uploads/ZIS_Healthform.pdf

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