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Wilfred College Additional Needs and Medical Conditions Form

Confidential Student Support Information

Wilfred College is committed to supporting the individual needs of all students. Please complete this form to inform us of any additional needs, medical conditions, or support requirements your child may have. All information provided will remain confidential and will only be shared with relevant staff as necessary to ensure your child’s well-being and educational success.

Student Information
Full Name *
Date of Birth *
Grade/Year *
Parent/Guardian Name(s) *
Contact Number(s) *
Email Address *
Medical Conditions
Please indicate if your child has any medical conditions or diagnoses (e.g., asthma, diabetes, epilepsy, allergies, etc.). If yes, provide details below:
Does your child have any medical conditions?
If yes, please specify:
Specify Medical Conditions
Is your child currently on any medication?
If yes, please list medications, dosage, and administration details:
Specify Medication
Allergies
Does your child have any allergies (food, medication, environmental, etc.)
If yes, please specify and describe the severity and treatment plan:
Specify Allergies
Emergency Action Plan
Does your child require an emergency action plan (for conditions such as severe allergies, epilepsy, etc.)
If yes, please attach or describe the plan below:
Emergency action
Additional Needs
Please indicate if your child has any additional educational, physical, sensory, behavioral, emotional, or communication needs (e.g., learning disabilities, ADHD, autism spectrum disorder, physical disabilities, speech and language needs, etc.).
Does your child have any additional needs?
If yes, please specify and provide details on support required:
Additional Needs
Professional Support
Is your child currently receiving or has received support from any professionals (e.g., doctor, pediatrician, psychologist, speech therapist, occupational therapist, counselor)?
If yes, please provide details (type of support, frequency, contact information if relevant):
Professional Support
Other Information
Please provide any other information you feel is important for the college to know to support your child's well-being and learning:
Parent/Guardian Declaration
I confirm that the information provided above is accurate and complete. I understand that this information will be kept confidential and used to support my child while attending Wilfred College. I agree to notify the college of any changes to my child's medical condition or support needs.
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