Healthy Ireland Junior Participant Consent Form 2019/20
Participant application form 2019/20 for Healthy Ireland Programme under 10's at Mulhuddart Community Centre
Sign in to Google to save your progress. Learn more
Email *
Name of Child *
Date of Birth *
MM
/
DD
/
YYYY
Name of Parent/Guardian *
Contact Number *
Contact Address *
Days of Attendance
Please tick beside each day you wish your child to attend
Which Day will your child be attending *
Required
Medical Information
Does your child suffer from any medical conditions/ illness/ special needs/ disability or Allergies?
Clear selection
If YES please provide more information
GP Name and address
GP Contact number
Accident and/or Emergency consent form
I/We parent/guardian of above applicant give Mulhuddart Community centre my permission to obtain emergency medical treatment for my child when I cannot be reached or if a delay in treating my child would be dangerous for him/her
Clear selection
Photography Policy
I/We parent/guardian of above applicant give permission for photos of our child/ren to be used by the centre for advertising purposes
Column 1
Newspaper/Newsletter
Facebook
Child Collection
Does your child have permission to leave the premises on their own to go home
Clear selection
Other Authorized person to collect Child
GDPR
General Data Protection Regulations (GDPR) requires us to have your consent to keep your information on file.  Please tick Yes or No to show if you consent to any of the following.
Do you consent to Mulhuddart Community Centre keeping your details on file
Clear selection
Do you consent to Mulhuddart Community Centre contacting you by phone/text/WhatsApp
Clear selection
Do you consent to Mulhuddart Community Centre contacting you by Email
Clear selection
If you would like to be contacted for future similar workshops or camps please tick here
Signed
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms