Booterstown Summer Project Registration

Parent/Guardian Information

Parent/Guardian Name: Parent/Guardian Email: Parent/Guardian Mobile: Alternate Contact Name: Alternate Contact Mobile:

Child Information

Child 1

Admission Ticket Number: Name: Date of Birth: Gender: Class (2024/2025): Medical/Allergy Info: Medical Detail: If you have additional information about this child that would be useful for the organisers to be aware of, please supply it here, or speak to a committee member in confidence.: Would you like us to try and pair your child in a group with a friend? Please provide friends name:

Child 2

Admission Ticket Number: Name: Date of Birth: Gender: Class (2024/2025): Medical/Allergy Info: If you have additional information about this child that would be useful for the organisers to be aware of, please supply it here, or speak to a committee member in confidence. Would you like us to try and pair your child in a group with a friend? Please provide friends name:

Child 3

Admission Ticket Number: Name: Date of Birth: Gender: Class (2024/2025): Does this child have any medical or allergy issues we need to be aware of?: If you have additional information about this child that would be useful for the organisers to be aware of, please supply it here, or speak to a committee member in confidence. Would you like us to try and pair your child in a group with a friend? Please provide friends name:

Consent and Permission

You received consent and code of conduct forms on arrival this evening. Please tick this box to confirm that you will sign and hand in these completed forms before leaving this evening?

Volunteer & Vetting

Each person who is providing supervision MUST have completed Garda Vetting provided by Crosscare, and an in-person Child Protection Training Course.

Do you agree to provide supervision for 1 day for each child you are registering: Nominated Supervisor(s): Has the supervisor(s) been Garda Vetted by Crosscare in the last three years? Has the supervisor(s) Completed Crosscare Child Protection Training in the last three years (if not, please attend on May 7th in the Pastoral Center 19:30 - 21:00):