2023 Cabra For Youth Registration Form

Cabra For Youth Clg

Youth Service Registration Form 2023
Personal & Contact Details
Young Person's Name*

First NameLast Name
Date Of Birth*

DayMonthYear
Current Date

DayMonthYear
Current Age ( Automatically Inputs)
Address of Young Person*

Street Address

Street Address Line 2

City ( Example Dublin 7 )State / Province

Eircode
Gender
Name of School / Training / Employment*
Please select the Area within Cabra the Young person lives*

WestEastDunardOther
Phone Number of Young Person
*By providing the Child/Young person’s mobile number you are consenting to contact from the Cabra for Youth Staff on issues relating to the project and its programmes via messaging services.

Emergency Contact Details
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Phone Number*
Please enter a valid phone number.
Second Emergency Contact Name

First NameLast Name
Second Emergency Contact Number
Please enter a valid phone number.
Second Emergency Contact Relationship to Young person
Eg , Sister , Uncle Grandparent etc

Consent

Consent to participate in Cabra For Youth Clg

The youth service provides a range of non-formal education programmes and activities for young people. These include weekly project based programmes, Drop Ins, Youth Forums, Interest groups, Residential, Youth exchanges, Adventure Sports and Water Sports. *

	Select One
I consent to my child participating in activities with Cabra for Youth
My child can swim 25m (1 pool length) or more
I consent to the use of images all social media platforms including via phone and text messaging

Consent for Photograph / Video use

In the course of the programmes run by the youth service, youth workers and young people may take photographs or video footage. I understand these will only be used for appropriate display publications as approved by management of the youth service.

Use of Images Consent*

	Select One
I consent to the use of images and videos being displayed in the youth service
I consent for use of images & videos in Brochures
I consent to the use of images on all social media platforms including phone and text messaging
I consent for use of images in grant applications

Technology Access

The youth service provides young people with access to computer technology and age appropriate internet usage. I understand that every reasonable precaution will be taken by the youth service to provide for online safety.

Technology Access Consent

	Select One
I consent to my child / Young person to using electronic devices which may include laptops , PC’s and tablets which may have internet access.
I consent to my child / Young person to engaging with the youth service online , this may including online gaming or video calls e.g. zoom calls

Anti-Social Behaviour Policy
The youth service does not tolerate the involvement of young people in 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 contacted and that young person asked to leave the activity. I agree to the above policy*

YesNo

Covid 19 Consent
I Parent / Guardian Name give permission for Young Person Full Name to participate in Cabra For Youth Activities.

By signing this I acknowledge the current risks associated with Covid-19 and that Cabra for Youth will endeavor to minimise 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 Yes No*
I hereby declare that the information supplied in this registration form is accurate at the time of signing and that I will inform the staff of CABRA for Youth immediately of any changes to the above details should they occur.*

YesNo
Please sign Below ( Parent / Guardian )*

Clear
Date of being Signed*

DayMonthYear
Young Person Over the Age of 18 years of Age Sign Below
Please sign Below (Young Person over the age of 18 years of age )

Clear
Drag & Drop Files if required

Cancelof
Should be Empty:

Cabra For Youth Clg

Personal & Contact Details

Emergency Contact Details

Medical / Additional Need Details

Note :

Consent

Consent for Photograph / Video use

Technology Access

Anti-Social Behaviour Policy

Covid 19 Consent

Young Person Over the Age of 18 years of Age Sign Below