SUMMER WEEK Consent Form
*For children who will be in primary 3 and 4 in September 2026*. Forms for different age groups can be found at www.linktr.ee/commonground26. Please complete a separate form for each child, thank you! We look forward to seeing you then!
Name of child
*
First Name
Last Name
Mornings attending at Islandmagee Primary School, 10.00am-noon
*
Monday
Tuesday
Wednesday
Thursday
Friday
Date of birth:
*
-
Day
-
Month
Year
Date
Child's Age:
*
School:
*
Year group in school in September 2026: (please indicate which class your child is going into after the summer holidays)
Year 3
Year 4
Address:
*
Name of parent/guardian
*
First Name
Last Name
Contact telephone number:
*
Email:
*
If I cannot be contacted, please contact (please write name and phone number):
*
The Summer Week team will update parents via WhatsApp with relevant and up to date information regarding the event. Do you give permission to be contacted via WhatsApp by the Leader in Charge?
*
Yes
No
Do you give permission for photographs and video to be taken of your child for Ballycarry/Islandmagee/Whitehead Presbyterian church publicity purposes, for example these will be used on Church website, Church Social Media, Church magazine?
*
Yes
No
Do you give permission for photographs and video to be taken of your child for SALT FACTORY SPORTS publicity purposes?
*
Yes
No
In the event of illness or accident, having parental responsibility, I give permission for first aid to be administered where considered necessary by a first aider. In the event of a medical emergency, leaders will endeavour to contact you as soon as possible using the contact numbers given.
*
Yes
No
Please indicate any medical conditions, special needs, allergies, or anything else which would be helpful for the leaders to know about: (This includes details on additional needs your child has which could impact on them being able to participate fully. If we know about your child's needs we will make every effort to have appropriate resources in place).
*
I will inform the leaders of any important changes to my child's health, medication or needs and also any changes of address and telephone numbers listed above...
*
Yes
No
I give permission for SUMMER WEEK to securely store the contact details in this form for 12months
*
Yes
No
Signature of Parent/Guardian
*
Date
*
-
Day
-
Month
Year
Date
Thank you for signing up for SUMMER WEEK 2026.
We look forward to welcoming you along! For more information please do not hesitate to contact Katherine Dickson (Youth Worker) on 07851665460 / katherine.islandmageepci@gmail.com. This form is being submitted to SUMMER WEEK @ Ballycarry/Islandmagee/Whitehead Presbyterian Church via a third party which is GDPR compliant.
Submit
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