Name: GCSE Maths and Science Workshop for Students
Start: 2023-07-07
End: 2023-07-07
Location: New College Worcester

Student Name*

Forename Surname

Parent / Carer / Guardian Details

Your name (First Parent/Carer/Guardian)*

Prefix First Last

Relationship to child

Your Email Address*

Enter Email Confirm Email

Your telephone number

Land line

Alternative Telephone Number (Eg Work Number)

Mobile Telephone Number*

Mobile telephone

Your Address*

House name or number Address Line 2 City County Post Code Country

Second Parent/Carer/Guardian Name

Prefix First Last

Relationship to child with vision impairment

Second Parent/Carer/Guardian Email

Second Parent/Carer/Guardian Telephone Number

Land line if different from above

Second Parent/Carer/Guardian Alternative Telephone Number

Eg Work Number

Second Parent/Carer/Guardian Mobile Telephone Number

Mobile Number

Second Parent/Carer/Guardian Address (if different from above)

House Name or number Address Line 2 City County Post Code Country

Who will be our Primary Contact (please check one box)*

Just First Parent/Carer/Guardian

Both first and second Parent/Carer/Guardians

Where did you first hear about NCW?*

Student Details

Name*

Forename Middle Surname

Legal Name (if different from above)

Forename Middle Surname

Date of Birth*

Current Age*

Please enter a number from 1 to 19.

Gender*

Male

Female

Other

Name of Current School*

Address of Current School

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

What Year Group is your child taught in?

First Language*

Ethnicity*

MEDICAL CONSENT FORM

These consents are valid while your child is at NCW.

Details of current GP*

Name of Practice, name of doctor, address and telephone number

Emergency Consent*

I give consent for any medical treatment, including surgery and/or anaesthetic, in an emergency situation as recommended by a qualified medical practitioner

I consent to my child being treated with non-prescribed medication, eg Paracetamol, Ibuprofen, cough linctus, throat lozenges, Gaviscon, anti-histamine, bite and sting spray, TCP, Sudocrem and ice packs (these are kept in surgery and the houses)

I consent to my child receiving first aid treatment in the event of an accident

Name of Student*

First Last

Name of person giving consent with parental responsibility*

First Last

Date*

GCSE Maths and Science Workshop for Students

Preparing for Exams (with medical)

Parent / Carer / Guardian Details

Student Details

Method of Working

STUDENT MEDICAL QUESTIONNAIRE

Eye Conditions

Medications

Allergies

Mental Health

FURTHER INFORMATION

MEDICAL CONSENT FORM

Date

Time

Location

New College Worcester

Organiser

Jeanette Normanton Erry

Email

Additional Links

GCSE Maths and Science Workshop for Students

Preparing for Exams (with medical)

Parent / Carer / Guardian Details

Student Details

Method of Working

STUDENT MEDICAL QUESTIONNAIRE

Eye Conditions

Medications

Allergies

Mental Health

FURTHER INFORMATION

MEDICAL CONSENT FORM

Date

Time

Location

New College Worcester

Organiser

Jeanette Normanton Erry

Email

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Additional Links