Athy Youth

Athy Youth Group
Registration & Consent Form
How: To register your interest, parents must fill in this registration and consent form. Reminders and updates will be sent out by Whatsapp. You only need to register once for the year.

When: Once a month on a Friday night, 8.00 - 10.00pm

Where: Athy Church of Ireland Centre.

What: A themed Bible study and related activities, games, and food.

Who: For those at secondary school.

How Much: There is no charge for the evening.

Organised by the Faith Mission Team, with local parents assisting
Name of Young Person #1*

First NameLast Name
Date of Birth #1*

DayMonthYear
Date
Name of Young Person #2

First NameLast Name
Date of Birth #2

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityCounty

Eircode
Parent's Email*

Confirmation Emailexample@example.com
Parent's Mobile Phone Number*
Emergency contact, if parent is unavailable*
Name and mobile number
Details of any known conditions, allergies (Eg asthma, diabetes epilepsy) and medications being taken for each young person.
Any other special needs, requirements which we should know about.
Consent
Consent
In the event of illness or accident, I give permission for first aid to be administered where considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitable qualified medical practitioner.

If I cannot be contacted and my child should require emergency hospital treatment, I authorise an adult leader to sign on my behalf any written form of consent required by the hospital. However I understand that every effort will be made to contact me as soon as possible.
Consent to all the above
Signature
Parent or Guardian's Name*

First NameLast Name
Should be Empty:

Athy Youth Group

Registration & Consent Form

Consent