Parent /Guardian

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Parent /Guardian

This form is to be completed each time your child wants to attend youth club.

Email *

In order to book in for LYCC Youth Club sessions, you must complete the following booking form each week. We require this information for the safety of all our members, staff and volunteers.

Provide answers that are true to the best of your knowledge.

Our youth clubs will follow public health guidance and Government Guidelines at all times.

If you have more than one child in the Youth Club, please fill out this form for each child.

Youth Club Member Full Name *

Please select your child's class/year from the list *

Is your child currently feeling well? *

Yes

- If you child is sick off school they cannot attend attend Youth Club.

- Please seek medical advice immediately if your child has any flu or Covid symptoms - Do NOT attend the group.

. What session would you like to book for? **** Please note €2 entry fee ****
*

24-Apr-2024 3:30PM-5:00PM - (4/35 seats remaining) - 6th Class - Wednesday

26-Apr-2024 3:30PM-5:00PM - (14/30 seats remaining) - 5th Class - Friday

Milkshakes - please advise if your child would like a milkshake - it can't be ordered on the day
*

Chocolate €1.50

Mint Choc €1.50

Vanilla €1.50

Strawberry €1.50

No Milkshake needed

Other:

Parent/Guardian Name *

Parent/Guardian phone number *

If my child develops any symptoms of illness, including of flu or Covid-19, I will keep my child home from Youth Club, and cancel the place I have booked (using cancellation form).

Date of declaration *

YYYY

Leixlip Youth & Community Centre
Newtown House, Captain's Hill, Leixlip, Co. Kildare
Phone: (01) 624 7435 Email: info@lycc.ie

Data Protection Notice. Your personal data is being collected on this form in order to help prevent the spread of COVID-19 at Leixlip Youth & Community Centre facilities. Your personal data is being processed in accordance with Article 9(2)(i) of the General Data Protection Regulation, and Section 53 of the Data Protection Act 2018. The information you provide on this form will not be used for any other purpose and will be strictly confidential. *Your information will be stored securely on the Leixlip Youth and Community Centre Management System.

Leixlip Youth Premises Group CLG is a registered Charity - RCN 20024666

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