Cambridge Easter Revision Registration Form

If you have any questions please email us at CambridgeEaster@mpw.ac.uk

or call: 01223 350 158

Student's Details

Title

First Name(s) (given)

Middle Name

Family Name

Preferred Name (if different)

Date of Birth (dd/mm/yyyy)

Gender

Year Group

Student's Mobile

Student's Email

The email address provided must be for the student, as both the fee payer and student are required to sign documentation to complete the registration process.

Current or Previous School/College

Name of School/College

Street

City

State / Province

Postcode / Zip Code

Country

Parent's Details

Please note, the details of person entered here will become the recipient of the tutor reports

Please tick if you are also the:

Fee PayerEmergency Contact

Relationship to Student

Title

First Name

Family Name

Email

Day-time Telephone

Mobile

Parent's Address

Street

City

State / Province

Postcode / Zip Code

Country

Fee Payer's Details

Please provide the details of person who will be paying the fees

Please tick if you are also the:

Emergency Contact

Relationship to Student

Title

First Name

Family Name

Email

Day-time Telephone

Mobile

Same address as parent:

YesNo

Fee Payer's Address

Street

City

State / Province

Postcode / Zip Code

Country

Emergency Contact Details

Please provide the details of person (in the UK) who can be contacted in the event of an emergency

Relationship to Student

Title

First Name

Family Name

Email

Day-time Telephone

Mobile

Emergency Contact Address

Street

City

State / Province

Postcode / Zip Code

Country

Student Availability

Dates Available (Select all that apply)

Week 1: Monday 31 March - Friday 4 AprilWeek 2: Monday 7 April - Friday 11 AprilWeek 3: Monday 14 April - Friday 18 April

Registrations cannot be confirmed until full details are provided. Please refer to the Course Outlines booklet when completing this section.

Subject To Be Studied

Level

Subject

Exam Board

Predicted Grade

Specific Weaknesses

Please provide weaknesses, even if this is just general revision.

GP Details

Name of GP

Street

City

State / Province

Postcode / Zip Code

Country

Medical Details

Dietary Requirements

YesNo

Please provide details

Does the student have any condition which is, or may be, life threatening?

YesNo

Please provide details

Please provide details of any medical condition which could affect the student's college life:

(e.g. physical disability, asthma, epilepsy, diabetes, heart disorder, deafness, depression, anorexia nervosa, etc)

Please provide details with dates of any serious injuries, illnesses or surgical operations:

Please provide details of any medication being taken:

Please provide details of any allergies:

(including allergies to drugs, especially Penicillin)

Please provide details of any other conditions which could affect the student's college life:

(e.g. anxiety, depression, phobias, PTSD, insomnia etc)

Accommodation

Is Accommodation Required?

YesNo

Accommodation Details

Dates & Prices

£662

Week 1: 30 March - 04 April

Week 2: 06 April - 11 April

Week 3: 12 April - 18 April

£265

Weekend 1: 05 April - 06 April

Weekend 2: 12 April - 13 April

Weekend 1 - Notice

Interim weekend at Corpus Christi College

Only available for students attending Week 1 courses and staying for Week 2 courses.

Lunch is not provided at the weekend - refer to accommodation leaflet

Weekend 2 - Notice

Interim weekend at Corpus Christi College

Only available for students attending Week 2 courses and staying for Week 3 courses.

Lunch is not provided at the weekend - refer to accommodation leaflet