A co-educational school in Jumeira, Dubai, JBS is a truly international school, offering The International Primary Curriculum (IPC), International General Certificate of Secondary Education (IGCSE).

1. ae
jbschool.www.T: +971 (0)4 344 6931
F: +971 (0)4 344 6754
Jumeira 1, on 53B Street, off Al Wasl Road
E: info@jbschool.ae
PO Box 211829, Dubai, United Arab Emirates Medical and Immunisation Record
and
Consent Declaration
Confidential
Please insert
student’s photo
here.
Child’s Name: _________________________________________
Please complete this form and return it to JBS prior to your child starting school.

2. www.jbschool.ae
Compulsory on Acceptance
The information provided will be treated as confidential by all JBS staff. If you have any queries, please feel free to
contact our Nurse, who will be happy to answer any questions.
Name of Child ____________________________________________________ Class ________________________________
Nationality _________________________________ Date of Birth _______________________ Gender M F
Father’s Name _____________________________________ Mother’s Name ______________________________________
Father’s Mobile ____________________________________ Mother’s Mobile ______________________________________
Physical Address ________________________________________________________________________________________
___________________________________________________ Home Telephone ____________________________________
Alternative Emergency Number(s)__________________________________________________________________________
Contact Person(s) ________________________________________________________________________________________
Please complete the following and tick ‘Yes’ or ‘No’ where applicable:
Illnesses Yes No Conditions Yes No
Please provide details for any of the above answered with ‘Yes’, inclduing treatment and regular medications
(continue on a separate sheet if required):
Family History
Diabetes Hypertension Stroke Tuberculosis Other ________________________________________
History of: Blood Transfusion No Yes, Frequency ________________________________________________
Hospitalisation No Yes, Frequency ________________________________________________

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Compulsory on Acceptance
Please ensure all consents are signed and dated.
Parental Consent
As the parent/guardian of ________________________________________________ (please print the child’s name) I give
consent to the following:
1. Consent for the administration of an over-the-counter medication
In the event that your child develops a fever or has pain it may be necessary to administer an over-the-counter
medication. If your child is unable to take certain medications, please contact the school nurse to advise her so
alternatives can be provided.
I consent to my child being given an over-the-counter medication such as Paracetamol or Neurofen should it be
considered necessary by the School Nurse.
Parent’s Name (please print) _____________________________________________________________________________
Signature _______________________________________________________ Date ______________________________
2. Consent for emergency treatment
In the event that your child requires emergency treamtment you will be contacted and asked to collect your child
from the school. If the school is unable to contact you, your child will be taken to a doctor/hospital for diagnosis
and treatment. Efforts to contact you will continue.
I consent to my child being taken to a doctor/hospital in the event of a medical emergency.
Parent’s Name (please print) _____________________________________________________________________________
Signature _______________________________________________________ Date ______________________________
3. Consent for medical examination
According to school health guidelines children require a school physical at certain phase stages in their life (KG1,
G1, G5, G9 and school leavers) and any child new to the Dubai School System.
This service is currently offered to you by JBS, however, if you wish to have your child examined by your own
family GP you may do so at your convenience. The school will require a copy of the doctor’s report for your
child’s health records. JBS has its own school doctor.
We would also like to reassure parents that the safety and wellbeing of the children are of prime importance to
us and they are supervised at all times during the examination by the School Nurse.
As parents you will be notified prior to any examination taking place and will be given the opportunity to attend.
I consent to my child having a school physical.
Parent’s Name (please print) _____________________________________________________________________________
Signature _______________________________________________________ Date ______________________________
Please note that all consents are valid for the period of time your child is attending JBS.

4. www.jbschool.ae
Compulsory On Admission
Immunisation History
The Department of School Health requires that the school maintains current information on each child’s
immunisation history. It is therefore important that Jumeira Baccalaureate School has a copy of your child’s
immunisation records.
JBS does not have an immunisation programme. Please make an appointment with your family GP for any
required immunisations.
(Please tick the appropriate box)
I have attached a copy of my child’s immunisation records
I will bring a copy to the nurse’s clinic as soon as possible
Previous Dubai School
Please complete below if your child previously attended another school in Dubai.
Name of previous school ________________________________________________________________________________
We have the school health booklet in our possession and will bring it to the nurse’s clinic
As far as we aware the previous school still has the health booklet