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| Children's Health Form (A copy of your child's immunizations will need to be attached to this.) Are your child's immunizations up to date?________________________ Does your child have any known allergies?__________________________________________________ _________________________________________________________ __________________________________________________________ _________________________________________________________ __________________________________________________________ ________________________________________________________ Does your child have any health conditions that I need to be aware of ________________________________________________________ describe___________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ has your child had any of the following .... Chicken box__________________ Mumps______________________ Measles________________________ Other______________________- Is your child prone to any common childhood illnesses? Ear infections_________________ Sore throat____________________ Stomach upset__________________ Colds_____________________ Headaches____________________ Does your child have any speech, hearing or visual problems? _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _ |