Family Support Step Up

  • Family Support - Engagement Consent Form Step Up

    These forms must be fullycompleted by persons who will engage in Family Support within the YDP & returned to; [Family Support Worker/ YDP contact information]

  • To Be Completed by Parent/Guardian

  • Format: 000 000 0000.

  • Step Up is part of the Youth Diversion Programme. The Youth Diversion Programme is co-financed by the Department of Justice and the European Social Fund Plus (ESF+) as part of the Operational Programme “Employment, Inclusion, Skills and Training (EIST)”. The data provided by you on this form will be collected and processed by Step Up in connection with your participation in the Youth Diversion Programme.

    Provision of the information sought below is not mandatory, and participants retain the right to choose not to disclose this information. Where participants exercise this right “Not Disclosed” should be ticked

     Click Here to view the leaflet 

  • Medical Information

  • Do you have any medical conditions that may impact your involvement in Family Support in the Youth Diversion Project?*
  • Do you have any other condition that staff should be aware of, which may require individual planning and consideration, including conditions affecting learning or social interaction?*

  • Consent

  • I understand that the Project works with other agencies; An Garda Síochána, Tusla and schools/education centres, social workers and counsellors to ensure that the family’s needs are met in the best way possible. This may involve sharing relevant information with them. I understand that the family’s needs will be assessed to help create a plan for them.  I also understand that this information may be used to compile statistical data to be transmitted to other relevant organisations; Department of Justice, Department of Further and Higher Education, Research, Innovation and Science, University of Limerick, European Union agencies and other relevant bodies which the Department of Justice may decide for the purpose of conducting evaluations and research. I understand that my pseudonymised data will be stored on behalf of the Department of Justice.  I understand that this information will be kept in accordance with the Data Protection Act 1988, 2003 & 2018.  I agree to this : :
  • Rows
  • The youth service does not tolerate the involvement of alcohol, drugs and/or sexual activity whilst engaging in activities with the service. If found to be engaging in any of the above, the parent/guardian will be to leave the activity. I agree to the above policy
  • Covid 19 Logo

  • By signing this I acknowledge the current risks associated with Covid-19 and that Cabra for Youth will endeavor to minimize these risks and implement all HSE guidelines. 

    I will make sure that my child/young person will adhere to social distancing and hand sanitisation guidelines and wear a mask where appropriate while engaging with Cabra for Youth Clg        *       

  • Consent

    This Youth Diversion Project is committed to providing a service to all suitable persons irrespective of their gender, ethnic background, culture, sexuality, ability, or religion. Our activities are based upon the principle of respect. Bullying in any form will not be tolerated. As a participant in the project, I agree to follow this equality statement. I also understand and agree to the project using what they know about me to plan activities and programmes to meet my needs in the best possible way.  
  • Date*
     - -
  • Government Ireland logo
  • Co Funded by European Union Logo
  • The Dormant Accounts Fund Logo
  • Irish Youth Justice Service

  • This project is co-funded by the Government of Ireland and the European Union

    For more information see www.eufunds.ie
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    • Additional Family member ( Over 18 ) 
    • Address same as Above?

    • Step Up is part of the Youth Diversion Programme. The Youth Diversion Programme is co-financed by the Department of Justice and the European Social Fund Plus (ESF+) as part of the Operational Programme “Employment, Inclusion, Skills and Training (EIST)”. The data provided by you on this form will be collected and processed by Step Up in connection with your participation in the Youth Diversion Programme.

      Provision of the information sought below is not mandatory, and participants retain the right to choose not to disclose this information. Where participants exercise this right “Not Disclosed” should be ticked

       Click Here to view the leaflet 

    • Medical Information Additional Person

    • Do you have any medical conditions that may impact your involvement in Family Support in the Youth Diversion Project?*
    • Do you have any other condition that staff should be aware of, which may require individual planning and consideration, including conditions affecting learning or social interaction?*
    • I understand that the Project works with other agencies; An Garda Síochána, Tusla and schools/education centres, social workers and counsellors to ensure that the family’s needs are met in the best way possible. This may involve sharing relevant information with them. I understand that the family’s needs will be assessed to help create a plan for them.  I also understand that this information may be used to compile statistical data to be transmitted to other relevant organisations; Department of Justice, Department of Further and Higher Education, Research, Innovation and Science, University of Limerick, European Union agencies and other relevant bodies which the Department of Justice may decide for the purpose of conducting evaluations and research. I understand that my pseudonymised data will be stored on behalf of the Department of Justice.  I understand that this information will be kept in accordance with the Data Protection Act 1988, 2003 & 2018.  I agree to this : :
    • Rows
    • The youth service does not tolerate the involvement of alcohol, drugs and/or sexual activity whilst engaging in activities with the service. If found to be engaging in any of the above, the parent/guardian will be to leave the activity. I agree to the above policy'

    • By signing this I acknowledge the current risks associated with Covid-19 and that Cabra for Youth will endeavor to minimize these risks and implement all HSE guidelines. 

      I will make sure that my child/young person will adhere to social distancing and hand sanitisation guidelines and wear a mask where appropriate while engaging with Cabra for Youth Clg        *       

    • Consent

      This Youth Diversion Project is committed to providing a service to all suitable persons irrespective of their gender, ethnic background, culture, sexuality, ability, or religion. Our activities are based upon the principle of respect. Bullying in any form will not be tolerated. As a participant in the project, I agree to follow this equality statement. I also understand and agree to the project using what they know about me to plan activities and programmes to meet my needs in the best possible way.  
    • Date
       - -
    • Under 18's Additional Consent (1) 
    • Address same as Above?

    • Step Up is part of the Youth Diversion Programme. The Youth Diversion Programme is co-financed by the Department of Justice and the European Social Fund Plus (ESF+) as part of the Operational Programme “Employment, Inclusion, Skills and Training (EIST)”. The data provided by you on this form will be collected and processed by Step Up in connection with your participation in the Youth Diversion Programme.

      Provision of the information sought below is not mandatory, and participants retain the right to choose not to disclose this information. Where participants exercise this right “Not Disclosed” should be ticked

       Click Here to view the leaflet 

    • Medical Information Additional Person

    • Do you have any medical conditions that may impact your involvement in Family Support in the Youth Diversion Project?*
    • Do you have any other condition that staff should be aware of, which may require individual planning and consideration, including conditions affecting learning or social interaction?*
    • I understand that the Project works with other agencies; An Garda Síochána, Tusla and schools/education centres, social workers and counsellors to ensure that the family’s needs are met in the best way possible. This may involve sharing relevant information with them. I understand that the family’s needs will be assessed to help create a plan for them.  I also understand that this information may be used to compile statistical data to be transmitted to other relevant organisations; Department of Justice, Department of Further and Higher Education, Research, Innovation and Science, University of Limerick, European Union agencies and other relevant bodies which the Department of Justice may decide for the purpose of conducting evaluations and research. I understand that my pseudonymised data will be stored on behalf of the Department of Justice.  I understand that this information will be kept in accordance with the Data Protection Act 1988, 2003 & 2018.  I agree to this : :
    • Rows
    • The youth service does not tolerate the involvement of alcohol, drugs and/or sexual activity whilst engaging in activities with the service. If found to be engaging in any of the above, the parent/guardian will be to leave the activity. I agree to the above policy'

    • By signing this I acknowledge the current risks associated with Covid-19 and that Cabra for Youth will endeavor to minimize these risks and implement all HSE guidelines. 

      I will make sure that my child/young person will adhere to social distancing and hand sanitisation guidelines and wear a mask where appropriate while engaging with Cabra for Youth Clg        *       

    • Consent

      This Youth Diversion Project is committed to providing a service to all suitable persons irrespective of their gender, ethnic background, culture, sexuality, ability, or religion. Our activities are based upon the principle of respect. Bullying in any form will not be tolerated. As a participant in the project, I agree to follow this equality statement. I also understand and agree to the project using what they know about me to plan activities and programmes to meet my needs in the best possible way.  
    • Date
       - -
    • Under 18's Additional Consent (2) 
    • Address same as Above?

    • Step Up is part of the Youth Diversion Programme. The Youth Diversion Programme is co-financed by the Department of Justice and the European Social Fund Plus (ESF+) as part of the Operational Programme “Employment, Inclusion, Skills and Training (EIST)”. The data provided by you on this form will be collected and processed by Step Up in connection with your participation in the Youth Diversion Programme.

      Provision of the information sought below is not mandatory, and participants retain the right to choose not to disclose this information. Where participants exercise this right “Not Disclosed” should be ticked

       Click Here to view the leaflet 

    • Medical Information Additional Person

    • Do you have any medical conditions that may impact your involvement in Family Support in the Youth Diversion Project?*
    • Do you have any other condition that staff should be aware of, which may require individual planning and consideration, including conditions affecting learning or social interaction?*
    • I understand that the Project works with other agencies; An Garda Síochána, Tusla and schools/education centres, social workers and counsellors to ensure that the family’s needs are met in the best way possible. This may involve sharing relevant information with them. I understand that the family’s needs will be assessed to help create a plan for them.  I also understand that this information may be used to compile statistical data to be transmitted to other relevant organisations; Department of Justice, Department of Further and Higher Education, Research, Innovation and Science, University of Limerick, European Union agencies and other relevant bodies which the Department of Justice may decide for the purpose of conducting evaluations and research. I understand that my pseudonymised data will be stored on behalf of the Department of Justice.  I understand that this information will be kept in accordance with the Data Protection Act 1988, 2003 & 2018.  I agree to this : :
    • Rows
    • The youth service does not tolerate the involvement of alcohol, drugs and/or sexual activity whilst engaging in activities with the service. If found to be engaging in any of the above, the parent/guardian will be to leave the activity. I agree to the above policy'

    • By signing this I acknowledge the current risks associated with Covid-19 and that Cabra for Youth will endeavor to minimize these risks and implement all HSE guidelines. 

      I will make sure that my child/young person will adhere to social distancing and hand sanitisation guidelines and wear a mask where appropriate while engaging with Cabra for Youth Clg        *       

    • Consent

      This Youth Diversion Project is committed to providing a service to all suitable persons irrespective of their gender, ethnic background, culture, sexuality, ability, or religion. Our activities are based upon the principle of respect. Bullying in any form will not be tolerated. As a participant in the project, I agree to follow this equality statement. I also understand and agree to the project using what they know about me to plan activities and programmes to meet my needs in the best possible way.  
    • Date
       - -
    • Should be Empty: