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.

When: Friday nights, 8.00 - 10.00pm
Friday 22 September
Friday 20 October
Friday 17 November
Friday 15 December
Friday 19 January
Friday 16 February
Friday 15 March
Friday 19 April
Friday 17 May
Friday 21 June

Where: Athy Church of Ireland Centre.

What: A themed Bible study and related activities, occasional crafts, 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
I give permission for my data to be stored by the Faith Mission and Athy Union of Parishes for notification of future events.*

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.
During the event, photographs may be taken for publicity purposes. They may be used on the church websites. On signing this form we assume that you have given permission for your child's photograph to be taken.*

Consent to all the above
Signature

Clear
Parent or Guardian's Name*

First NameLast Name
Should be Empty:

Athy Youth Group

Registration & Consent Form

Consent