KCL PREHOSPITAL CARE PROGRAMME APPLICATION FORM

MEDICAL STUDENTS

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.

This is used to contact you in case of emergency.
You must use your KCL email address (e.g. joseph.bloggs@kcl.ac.uk)
Please select your year of study. Unfortunately, do not currently allow intercalating students to join the PCP due to insurance/indemnity reasons.

Please upload either your MDU/MPS card or certificate of insurance.

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.

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.
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 by all KCL PCP Paramedic mentors. It will be sent to the relevant LAS team in order to facilitate the shift.

This year the PCP team is carrying out a study to better understand how the PCP influences medical students' clinical skills and experience, via a pre and post programme short questionnaire. Please read the information sheet and upload a completed copy of the following consent form indicating your preference regarding participation.

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