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School of Nursing & Midwifery

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School of Nursing & Midwifery Summer School 2013

5th June – one day event
Registration Form

You have entered some required information incorrectly:

*=Required information

PERSONAL INFORMATION:

*Student Name:

*Address:

*Home Phone No:

*Email:

*Student Mobile No:

*Date of Birth:

*School:

Male/Female

Male
Female

*Year at School:

*Year (which you intend sitting the Leaving Certificate):

AREAS OF INTEREST IN NURSING/MIDWIFERY:

(please tick all that apply to you)

General Nursing
Midwifery
Psychiatric Nursing
Other:

FEEDBACK:

*Where did you hear about this Summer School? Please tick one appropriate space:

Friend
Leaflet from School
Internet
Relative
Teacher
NUI Galway Open Days
School visit

TOP 5 CAO PREFERENCES:

(please specify):

HEALTH:

The Programme will not be held responsible for non-disclosure of any medical condition.

Please list details of any special medical or dietary requirements:

Contact Number in case of Emergency:

Name:

Home Phone No:

Mobile No:

FEES:

A fee of €30 applies to this event and will cover costs of lunch refreshments.

Return €30 registration fee by post to: School of Nursing & Midwifery, Aras Moyola, NUI Galway.

Fee should be sent as cheque or money order made payable to "School of Nursing & Midwifery, NUI Galway".

Places are limited. Receipt of application form and fee does not guarantee a place on the programme. Students will be informed whether they have a place on the programme closer to the event. The fee will be returned to those who do not obtain a place.

Summary of Rules and Procedures:

All students attending the programme at NUI Galway shall maintain acceptable standards of behaviour and shall act in a law-abiding, mature and honest fashion.
Smoking, alcohol and other drugs are strictly forbidden, regardless of parent's attitudes to such matters while the student is at home.
Certain areas of the campus will remain out of bounds to programme participants, in the interest of safety and in maintaining a high level of supervision. These areas will be indicated to Participants in the Welcome Address.
University Property must be respected and the directions of Programme Staff adhered to at all times.
Safety procedures as laid down by the University, must be followed.
The University will not be held liable for any property lost, damaged or stolen.

Failure to comply with these rules, which exist to ensure an enjoyable and beneficial programme for all participants, will warrant immediate expulsion, in which case no reimbursement of costs will be made.

Note: photographs may be taken during Workshop sessions for PR purposes. Permission will be taken as granted on receipt of application form unless otherwise stated in writing by Parent / Guardian.

Note: In the event that we are heavily over subscribed for the Summer School, places will be allocated according to early application and level of demand for particular areas of interest.

We have carefully read the Rules and Procedures and we agree to observe them.

*Please tick

*Student Name:

*Date: