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Health Application Form


Health Application Form

The World School,
Below Dominos,
South Enclave, Solan

Genral Information

Yes No
_asthma
_sensitive skin
_sleep walking
_nosebleed
_earache
_sinus trouble
_convulsions
_high blood pressure
_fainting
_frequent colds
_headache
_motion sickness
_tonsillitis
_nightmares
_bed wetting
_allergies (describe)
_eye infection
_bronchitis
_kidney problem