[精品]健康证明书

[精品]健康证明书 International Buddhist College 88, Mu 2, Thung Mo Subdistrict, Khuan Sato, Amphoe Sadao, Songkhla 90240, Thailand. HEALTH CERTIFICATE 健康证明书 (To be completed by Parents / Guardian 父母或监护人填写) PRIVATE & CONFIDENTIAL 私人和保密 Name of student 姓名: Date of birth 出生日期: Sex 性别: Religion 宗教: Address 住址: MEDICAL HISTORY 医药背景 Any recent illness? 最近是否生过病, Past history of child 孩提时的医药背景: Any serious illness or disorders in the family: 家族 / 家庭中有无任何严重的疾病, Any allergies? 有无任何过敏, Any disturbing social habits? e.g : Tobacco 抽烟 : Drugs 吸毒 : 有无对社会有干扰性的不良习惯,如: Alcohol 饮酒 : Others 其他 : Immunisations免疫: Derails of any medication/ drugs the student is currently taking: 目前服用药物: PARENTS ARE STRONGLY ADVISED TO HAVE THEIR CHILDREN IMMUNISED. 我们强烈建议家长为申请人进行免疫注射。 P.S THIS FORM IS TO BE RETURNED TO REGISTRAR BEFORE COMING TO IBC. 此《健康证明书》必须于入学前寄交本校。