Pupil Registration for the RESIDENTIAL MSC summer school (July 2021) Journey to Medicine
Event Timing: July 2021 (provisionally 6-9July TBC)
Event Address: West Buckland school, West Buckland School, Barnstaple, Devon, EX32 0SX
Contact erin@catalysis.org.uk
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 *
Date of birth *
Home address *
Gender *
Current or most recent school attended or EHE *
The name and email address of a teacher who can provide a reference for you if needed *
Name of school or college (or current educational location) *
Name of a teacher who can provide a reference for you. *
Email contact for the teacher providing a reference (or the school email) *
We will select students for the summer school based on a range of eligibility criteria. Please answer the following questions as fully as possible.
• Are you eligible for free school meals? *
Required
• Have you spent time in local authority care? *
Required
• Are you a young carer? *
Required
• Have either of your parents got a university degree from either the UK or abroad? *
Required
• Are you a refugee or asylum seeker? *
Required
• Are you estranged (living without family support)? *
Required
What do you want to achieve from attending the MSC Summer School? [150 word limit] *
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.
Personal Information of Parent/Legal Guardian. We need to know your details if we need to contact you
Name *
Relationship to student *
Home address (if different to address above) *
Contact number *
Email address *
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 *
DATE *
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 *
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.
Has the student any disability, illness or medical condition that may affect their ability to fully participate in the Summer School? *
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.
*
Required
Code of Conduct
Code of Conduct page 2
A copy of your responses will be emailed to the address you provided.
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