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Pupil Registration for the Medical MSC summer school (July 2021) Journey to Medicine
Event Timing: July 2021 (provisionally 6-9July TBC)
Event Address: Online or if residential at West Buckland school, West Buckland School, Barnstaple, Devon, EX32 0SX
Contact
erin@catalysis.org.uk
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Email
*
Your email address
All students under the age of 18 require consent from a parent or guardian to participate in the Journey to Medicine Summer School.
Student’s Details
Name
*
Your answer
Date of birth
*
Your answer
Home Postcode
*
Your answer
Gender
*
Female
Male
Other / neither
The name and email address of a teacher who can provide a reference for you if needed
*
Your answer
Name of school or college (or current educational location / EHE)
*
Your answer
We will select students for the summer school based on a range of eligibility criteria. Please answer the following questions as fully as possible.
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Are you eligible for free school meals?
*
Yes
No
Don't know
Prefer not to say
Required
•
Have you spent time in local authority care?
*
Yes
No
Don't know
Prefer not to say
Required
•
Are you a young carer?
*
Yes
No
Don't know
Prefer not to say
Required
•
Have either of your parents got a university degree from either the UK or abroad?
*
Yes
No
Don't know
Prefer not to say
Required
•
Are you a refugee or asylum seeker?
*
Yes
No
Don't know
Prefer not to say
Required
•
Are you estranged (living without family support)?
*
Yes
No
Don't know
Prefer not to say
Required
What do you want to achieve from attending the MSC Summer School? [150 word limit]
*
Your answer
Declaration. The information provided is true and correct. I understand that in providing incorrect information any offer of a place of a summer school can be revoked. I am happy for this data to be shared with the teacher who will provide further information.
Tick to confirm the declaration
Personal Information of Parent/Legal Guardian. We need to know your details if we need to contact you
Name
*
Your answer
Relationship to student
*
Your answer
Home address (if different to address above)
*
Same as above
Other:
Contact number
*
Your answer
Email address
*
Your answer
The student and a parent or legal guardian should read the information below. Please tick the appropriate boxes to indicate agreement.
PARENT / GUARDIAN TO CONFIRM PARTICIPATION CONSENT:
NAME OF PARENT / GUARDIAN
*
Your answer
DATE
*
Your answer
I CONFIRM THAT I HAVE READ AND UNDERSTAND THE PROGRAMME INFORMATION FOR THE MSC SUMMER SCHOOL I GIVE CONSENT FOR MY CHILD TO TAKE PART IN THE PROGRAMME
*
Tick to confirm agreement
Required
It would help us to know of any medical conditions. This information is required to make sure that we are aware of any additional requirements to help us provide the best possible experience. This information will not be kept beyond the summer school. Please answer all of the questions 'Yes' or 'No'. If you answer yes, please give further details here.
Your answer
Has the student any disability, illness or medical condition that may affect their ability to fully participate in the Summer School?
*
Yes
No
Parents/Legal Guardians and students are required to sign this document to indicate that they have read and understand the requirements, including the code of conduct at the end of this page. This must be completed and returned to us before the start of the Summer School.
*
I understand that I/my child must adhere to this code of conduct to ensure a safe and enjoyable programme for all involved.
Required
Code of Conduct
Code of Conduct page 2
A copy of your responses will be emailed to the address that you provided.
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