Please complete our application form below. All fields are mandatory as this information is required for insurance/indemnity reasons.
Copies of documents may be uploaded as images (e.g. taken by camera). All applications are reviewed by the PCP team and will be processed within 10 working days.
Enter password again *
First Name *
Last Name *
Mobile Number *
This is used to contact you in case of emergency.
KCL Email Address *
You must use your KCL email address (e.g. firstname.lastname@example.org)
Term Time Address *
Please select your course. *
Select an optionBScPGDip
Which area of nursing are you training in? *
Select an optionAdultChildMental Health
Please select your year of study. *
Select an option123
Why do you want to take part in the Prehospital Care Programme? (approx 150 words) *
Talk about any relevant experiences you have. (approx 150 words) *
Upload a copy of your KCL ID card *
Upload a copy of your RCN card *
Please upload a copy of your RCN card
Please download and complete the following London Ambulance Service indemnity form. This form must be countersigned by a witness and must be taken with you on every ambulance shift.
Upload your completed LA123 Indemnity 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 of Next of Kin to you *
Next of Kin Mobile Number *
I confirm that I have watched the LAS observer shift training video *
I confirm that I have purchased KCL Emergency Medicine Society membership from the KCLSU website *
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:
KCL Emergency Medicine Society
KCLSU, Boland House
St Thomas Street
Danny Dwyer - KCL EMS President
Jessica Curtis - KCL EMS Vice President
Elsa Desmond - Events Director
Abigail Burrows - Sponsorship Officer
Meet the Team
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King's College London Emergency Medicine Society • © Shadman Aziz 2016 - 2018 • All Rights Reserved