MARINA(JBR) BR. MEADOWS BR. POLO BR. 04 454 8404 04 551 6335 04 424 3791 04 422 4222 04 368 9882 LAKES BR. ALFURJAN BR. JEBEL ALI VILLAGE NURSERY LLC Established since 1976 P.O. Box 53951, Dubai, U.A.E., Tel: +971 4 4243791 / 2, Fax: +971 4 4243790 E-Mail: [email protected] Website: www.jebelalinursery.com MEDICAL FORM P 1 Name of Child ………………………………………………………………....... Date of Birth …………………………………………………….…. Home telephone number ………………………………………………….. Office number........................................................... Mother’s Mobile .................................................................... Father’s Mobile ........................................................ Emergency number (other than parents) ……………………………..................... /........................................................... Family Doctor ……………………………………………………………………. Clinic …………………………………………………….……………… Dear parents, The Department of Health requires that all nurseries maintain a record of each child’s medical history. Therefore, we would appreciate if you could complete the following and return it to ................................................................................................................. ................................................................................................................................................................................... ...................................................................................................................... ................................................................................................................................................................................... ............................................................................................................. ................................................................................................................................................................................... No No No Yes Yes Yes No No No No Yes Yes Yes Yes Heart Disease Epilepsy G6PD Asthma Tuberculosis Pneumonia If your child suffers from any allergies