Only answer if you've selected
'Yes'
for
field-01
Child details
02
Your child's first name *
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'Yes'
for
field-01
03
Your child's last name *
Only answer if you've selected
'Yes'
for
field-01
04
Your child's sex at birth *
Please select
Male
Female
Only answer if you've selected
'Yes'
for
field-01
Only answer if you've selected
'Yes'
for
field-01
05-1
Your child's join date *
Please select
September 2025
Only answer if you've selected
'Yes'
for
field-01
05-2
You have entered an enrolment date of [DATE]
. Please confirm this is correct. *
Only answer if you've selected
'Yes'
for
field-01
Appointment of an Appointed Guardian
Appointing someone else to manage your child's claims (Appointed Guardian)
How can I appoint an Appointed Guardian?
If your child is under 16
You can appoint Appointed Guardian/s to manage their claim/s by providing their details in this form. You and other Parents/Legal Guardians will still be able to manage your child's claims.
If your child is over 16
You'll need their consent before appointing Appointed Guardian/s to manage their claims. Even Parents/Legal Guardians need to be appointed in this form to manage claims on behalf of their child if the child is over 16.
Who can be an Appointed Guardian?
Appointed Guardian/s could be the school, or someone else or both - e.g. it could be you and another Parent if your child is over 16 (if your child is under 16, you don't need to be formally appointed), another relative or family friend. Appointed Guardians must be over 21 years old.
What can an Appointed Guardian do?
Details of what an Appointed Guardian can do are provided below. Importantly, only Parents and Legal Guardians are ever able to cancel or amend your child's cover.
Where does correspondence about the AXA Health Pupils' Healthcare Scheme go?
All correspondence will be addressed to the child, care of the school (for example, Child Name, c/o Sample School, Sample Town, UK, A1 2BC).
Your child will be responsible for passing it to you or any other Parent, Legal Guardian or Appointed Guardian.
If you and your child would like to amend your Appointed Guardian choices in the future, please contact us on pupilshealth@thephc.co.uk and we will be happy to assist you.
19-00
Please tick to confirm that you have read and accept the information above. *
Only answer if you've selected
'Yes'
for
field-01
Only answer if you've selected
'Yes'
for
field-01
19-2
I am not appointing any Appointed Guardian/s. I understand that I am
responsible for managing any claim/s for my child and that AXA Health will
send all correspondence to the school, who will forward it to my child to
act upon as required.
*
19-4
My child has chosen to manage their claim/s themselves.
*
19-5
I confirm that my child has consented to the Appointed Guardian/s appointed
in this form.
*
19-6
My child/I understand that AXA Health will share medical information with the Appointed Guardian/s to manage any claims/s for my child.
*
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'Yes'
for
field-19-02
OR
Only answer if you've selected
'Yes'
for
field-19
OR
Only answer if you've selected
'Yes'
for
field-19-1
Only answer if you've selected
'Yes'
for
field-19-02
OR
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'Yes'
for
field-19
OR
Only answer if you've selected
'Yes'
for
field-19-1
19-1-1
Appointed Guardian's first name *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-2
Appointed Guardian's last name *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-3
Telephone number(s) *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-4
Relationship to child *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-5
Email address *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-6
Address line 1 *
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'Yes'
for
field-19-1
19-1-7
Address line 2 *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-8
Address line 3 *
Only answer if you've selected
'Yes'
for
field-19-1
19-1-9
Address line 4
Only answer if you've selected
'Yes'
for
field-19-1
19-1-10
Post code / ZIP code *
Only answer if you've selected
'Yes'
for
field-19-1
Only answer if you've selected
'Yes'
for
field-19-1
So that we can be sure we're speaking to the right person, please provide a
memorable date that will identify the Appointed Guardian when they call.
Only answer if you've selected
'Yes'
for
field-19-1
Only answer if you've selected
'Yes'
for
field-19-1
Please provide a hint/reminder that we can ask the Appointed Guardian, to
help remember their chosen date if they forget - e.g. the Authorised
Guardian's birthday or wedding date.
19-1-12
Memorable date hint / reminder *
Only answer if you've selected
'Yes'
for
field-19-1