Guest Application Form

Guest Application Form

Kilcuan, Clarinbridge, Galway H91 W596 Email info@irishpilgrimagetrust.com Tel 091 796622 Charity Reg 20009953 Rev No CHY5992 www.irishpilgrimagetrust.com
COMPLETION OF AN APPLICATION FORM DOES NOT GUARANTEE SELECTION
Please select which one you are applying for

EASTER PILGRIMAGE TO LOURDES Closing Date 31st October for children/young people with additional needs age 11 to 30 years: For children with serious or terminal illness up to the age 11, accompanied by a parent or guardian. Applicant, if selected will join the Trust Pilgrimage to Lourdes as our Guest. FRIENDSHIP WEEKS SUMMER in Kilcuan Galway and Cois Cuain Wexford Closing Date 31st May - for children/young people and older adult with additional needs who contribute to the cost of the week. SUMMER LOURDES PILGRIMAGE staying in HOSANNA HOUSE, Bartres Closing Date 31st May - for young people and adults with additional needs who pay their own fare.
Please note that:-

The information provided by you on this Application Form will be used by The Irish Pilgriamge Trust to assist in the Selection of Guests on our Easter Pilgrimages to Lourdes, Hosanna House or on holiday to Kilcuan, Galway and Cois Cuain, Wexford during the Friendship Weeks. You, as the provider of the information are entitled to recitfy the information, if inaccurate or processed unfairly. In addition, where the personal information on this form is not obtained from the Guest personally the Guest is entitled to a copy on this informmation on request.
The Irish Pilgrimage Trust is totally dependent on Fundraising.

Any Donation would be gratefully received.

All Trust Volunteers undergo Vetting and pay their own fare.

SECTION 1

Contact Information
Applicant Name *

Surname First Name
Date of Birth *
Age *
Gender *
Address *

Address 1

Address 2

Address 3 Address 4

Postal / Eircode
Email *
example@example.com
Applicant Contact Phone Number *
Valid Passport *

Yes No
Applicant's Nationality *
First Parent's Name
First Parent's Contact Phone Number
Second Parent's Name
Second Parent's Contact Phone Number
Name of Guardian, only if different from parents
Contact Number for Guardian
With whom does the applicant normally live? *

Mother Father Both Guardian Independently Other
If Other, please state
Name and Address for Correspondence(only if different from Home Address)

SECTION 5
DATA PROTECTION STATEMENT

The Irish Pilgrimage Trust will only process your information for the reason/extension of the reason that it was obtained. Your data will not be passed onto third parties or accessed by any unauthorised individuals. Your data will be stored securely and will be processed in association with relevant GDPR and Data Protection legislation.

By signing this APPLICATION FORM you agree to allow the processing of your data by The Irish Pilgrimage Trust.

WITHDRAWAL OF CONSENT :- I/ We understand that consent may be withdrawn at any time by submitting written notification of such to the Trust’s National Co-ordinator at the head office of The Irish Pilgrimage Trust, Kilcuan, Clarinbridge, Galway, H91 W596
I agree with The Irish Pilgrimage Trust Data Protection Statement as stated above *

I Agree
By SIGNING this Application Form

I / We hereby agree with the Statements and Terms contained herein and above and I /we confirm that, to the best of my/our knowledge, all information provided is correct and accurate at the time of completing this Application Form.

I / we understand that completing, signing and submitting this Application Form does not guarantee selection.
SIGNATURE OF PARENT/LEGAL GUARDIAN/APPLICANT IF OVER 18

Please sign Signature*
Printed name
Dateblank*
SIGNATURE OF PARENT/LEGAL GUARDIAN
Relation to Applicant blanks
Please sign Signature
Dateblank
SIGNATURE OF APPLICANT
Please sign Signature
Dateblank
Should be Empty:

Guest Application Form

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