Application and Permission Form for Clubs in Foróige

To be completed by a Parent/Guardian. Please have payment information handy before submitting this form.

Parent/Guardian First & Last Name^*

Parent/Guardian Home Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Zip ^*

Parent/Guardian Email^*

Parent/Guardian Mobile Phone Number^*

How many children are you registering?^*

Please advise that the answers provided in the section containing medical conditions, outside of COVID-19, may impact your child/wards participation within Foróige.

Young Person 1 Information

Club Selection:^*

Rockland
Yonkers

First & Last Name^*

Birthday^*

If 12 or older, include young persons Email

Mobile Number^*

Grade^*

T-Shirt Size^*

Should my child develop any COVID symptoms or have a COVID exposure, I will inform the Club Leader and not allow my child to attend the club until they complete the isolation period recommended by the CDC.^*

I confirm

Does the young person have any medical conditions that may impact on their involvement in Foróige? If yes, please provide details.^*

Does the young person have any other condition that staff/leaders should be aware of, which may require individual planning and consideration, including conditions affecting learning or social interaction? If yes, please provide details.^*

I grant permission for the applicant to take part in programs/games/activities in Foróige.^*

I confirm

I grant permission for the applicant to be included in photographs or video images which may be taken whilst attending or participating in Foróige activities and I consent to it being used by Foróige for items like Annual Reports, event reports or on Foróíge websites or social media channels.^*

I grant permission for the applicant to participate in supervised online meetings and activities.^*

Young Person 2 Information (if applicable)

Club Selection:^*

Rockland
Yonkers

First & Last Name

Birthday^*

If 12 or older, include young persons Email

Mobile Number^*

Grade^*

T-Shirt Size^*

I confirm

Does the young person have any medical conditions that may impact on their involvement in Foróige? If yes, please provide details.^*

I grant permission for the applicant to take part in programs/games/activities in Foróige.^*

I confirm

I grant permission for the applicant to participate in supervised online meetings and activities.

Young Person 3 Information (if applicable)

Club Selection:^*

Rockland
Yonkers

First & Last Name^*

Birthday^*

If 12 or older, include young persons Email

Mobile Number^*

Grade^*

T-Shirt Size^*

I confirm

Does the young person have any medical conditions that may impact on their involvement in Foróige? If yes, please provide details.^*

I grant permission for the applicant to take part in programs/games/activities in Foróige.^*

I confirm

I grant permission for the applicant to participate in supervised online meetings and activities.^*

Young Person 4 Information (if applicable)

Club Selection:^*

Rockland
Yonkers

First & Last Name^*

Birthday^*

If 12 or older, include young persons Email

Mobile Number^*

Grade^*

T-Shirt Size^*

I confirm

My young person is vaccinated.^*

Yes
No, My young person is not vaccinated and will wear a mask.

Does the young person have any medical conditions that may impact on their involvement in Foróige? If yes, please provide details.^*

I grant permission for the applicant to take part in programs/games/activities in Foróige.^*

I confirm

I grant permission for the applicant to participate in supervised online meetings and activities.^*

I have read and understood the following: 1) Foróige is not responsible for my child / ward before each session/meeting/trip begins or after it ends. 2) Leaders must be informed if my child / ward is taking medication at Foróige. Leaders cannot administer medication. My child should only have the amount of medication needed for the duration of the activity. 3) Foróige will follow policies and rules to promote good behavior and safety for all. 4) I will be informed if my child is going on an outing with Foróige. For longer or overnight trips, extra permission will be sought.^*

I confirm

On behalf of the above named, I understand that the Personal Data given on this form will be used by Foróige for the contractual purposes of registering (or re-registering) and maintaining the Applicants membership/participation. I understand that the Personal Data will be retained by Foróige for such period as the Applicants Membership/participation exists and thereafter will be retained by Foróige in line with its Data Retention Periods. I understand that the Applicants Personal Data will be used to maintain their membership/participation including administration, registrations, participation in events and activities, disciplinary matters, incident/accident reports and for statistical purposes. I understand that if I do not provide the Applicants Personal Data their Membership/participation cannot be registered with Foróige. I have read the Data Protection Information and understand that the data will be used to provide me with updates regarding Foróige activities such as meetings, events, activities, trips away and other matters relevant to my child/ward's participation in Foróige.^*

I consent to the above application

I understand that information on Foróige's Privacy Statement is available on www.foroige.ie or by contacting info@foroige.ie^*

I confirm

When possible, would you be interested in helping out or volunteering?

Please Confirm how many children you are registering in Foroige before selecting Submit & Pay^*

Please enter the Email address where you like to receive payment confirmation:^*