Nursing Student Reactivation Form RM_Stats First Name * Last Name * KCL Email * Non-KCL email * Date of birth * Mobile Number * Please provide a mobile number which we can use to contact you in case of emergency. Term Time Address * Please select your course. * Select an option BSc PGDip Which area of nursing are you training in? * Select an option Adult Child Mental Health Please select your year of study. * Select an option 1 2 3 Please download and complete the following London Ambulance Service indemnity form. Please complete all 3 pages where indicated. Under 'Emergency Contact' please provide BOTH A NAME & PHONE NUMBER. Leave the 'call sign' and 'authorising manager' section blank. Upload your completed Indemnity Form (all pages of our new updated form) * We also require the details of your next of kin. This is so we can contact them in the case of an emergency or if you are involved in a road traffic collision whilst in the ambulance. It is also a requirement of the LAS for you to go on shift with them. Name of Next of Kin * Relationship to Next of Kin * What is your relationship to your next of kin? Next of Kin Mobile Number * Please provide a mobile number for your next of kin which we can use to contact them in case of emergency. Your Indemnity form, including NOK details, will be accessible to all KCL PCP Paramedic mentors. It will be sent to the relevant LAS team in order to facilitate the shift. Please ensure these details are accurate as shifts will not be approved without them. I consent to all data shared in this registration being shared with the relevant PCP and LAS teams/team members. * I consent. I do not consent. PCP applications can not be approved without consent to share this data with the aforementioned teams. Please email [email protected] if you have any queries. I confirm that I have purchased KCL Emergency Medicine Society membership from the KCLSU website * Yes Nursing students are required to submit their ongoing achievement record (OAR) pages from each placement they have completed. I.e. Nursing students at the end of 2st year will be required to submit 6 OARs, students at the start of their programmes will have no OARs to submit etc. This is a requirement from the nursing school and is not controlled by the PCP team. Any OAR issues will be considered on a case-by-case basis. Please feel free to get in touch with the PCP team if you have any concerns or questions about OAR. Ongoing Achievement Record Page - Year 1 Placement 1: Ongoing Achievement Record Page - Year 1 Placement 2: Ongoing Achievement Record Page - Year 1 Placement 3: Ongoing Achievement Record Page - Year 2 Placement 1: Ongoing Achievement Record Page - Year 2 Placement 2: Ongoing Achievement Record Page - Year 2 Placement 3: Ongoing Achievement Record Page - Year 3 Placement 1: Ongoing Achievement Record Page - Year 3 Placement 2: Ongoing Achievement Record Page - Year 3 Placement 3: JavaScript is turned off in your browser. The form may not work properly.