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Clárú/Registration: Club Óige 2025/2026
Tabhair faoi deara go gcaithfidh duine atá freagracht tuismitheoirí acu an fhoirm seo a líonadh isteach.
Feic an nasc a leanas le tuilleadh eolais a fháil le do thoil:
https://en.gloruachtartire.com
Sonraí teagmhála agus tuilleadh eolais:
gloruachtartire@hotmail.co.uk
; 07501 252027
Please note this form must be completed by a person with parental responsibility.
Please see the following link for more information :
https://en.gloruachtartire.com
Contact Details and more information:
gloruachtartire@hotmail.co.uk
; 07501 252027
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Ainm an pháiste/ Child's Name
Your answer
Dáta Breithe/ Date of Birth
MM
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DD
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YYYY
Ainm scoile atá do pháiste ag freastail/ School your child attends
Your answer
Bliain scoile do pháiste/ Your child's school class year ie Rang 7, Bliain 8, 9, 10:
Your answer
Tugaim cead do mo pháiste a bheith páirteach i ngach imeacht a bheas ar siúl i rith Club Óige 2022/2023. Aontaim agus Deimhním go mbeidh údarás ag an dhuine atá i mbun an chúrsa thar mo pháiste agus go mbeidh cead acu treoir dhleathach a thabhairt do mo pháiste mar a dhéanaim fhéin. Má aontaíonn tú leis seo, scríobh d'ainm thíos anseo le do thoil. / I give permission for my child to partake in all activities organised during Club Óige throughout 2022/2023. I authorise and agree that the persons running the club shall have authority over my child and have the right to give lawful instructions to my child to the same extent as I myself, would do. If in agreement, please print your name:
Your answer
Please sign your name if you and your child agree that the rules of the Club Óige must be followed to the best of their ability.
Your answer
Scríobh dáta den lá atá inniu ann le do thoil: / Please write today's date:
MM
/
DD
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YYYY
Seoladh ríomhphost an thuismitheora/ Parent's/Guardian's email address
Your answer
Uimhir fóin an thuismitheora/ Parent's/Guardian's phone number
Your answer
Uimhir Fóin eile i gCás Éigeandála / Alternative Emergency Contact Number:
Your answer
Cén baint atá ag an duine seo le do pháiste?/ Relationship of owner of emergency contact number to your child?
Your answer
Eolas Sláinte agus Cead Leighis / Medical Details & Medical Consent Form
GP Name:
Your answer
GP Telephone Number:
Your answer
GP Address:
Your answer
An féidir leat dearbhú má bhfaigheann do pháiste toradh deimhneach fá choinne Covid-19, nó má bhfaigheann duine eile i do bhaile toradh deimhneach fá choinne Covid-19, NACH mbeidh do pháiste ag freastail an Chlub Óige go dtí go mbeidh an seal de féinleithlisiú thart . / Can you confirm that if your child tests positive for Covid 19 or if anyone in your household tests positive for Covid 19, that your child will NOT attend the Youth Club until the period of self-isolation is over.
Yes
No
Clear selection
An bhfuil tinneas tromchúiseach ag do pháiste? / Has your child any serious illnesses?
Yes
No
Clear selection
An bhfuil ailléirge ag do pháiste do penicillin? / Is your child allergic to penicillin?
Yes
No
Clear selection
An nglacann do pháiste cógas go rialta? / Does your child take any regular medication?
Yes
No
Clear selection
An bhfuil ailléirge ag do pháiste do chógas ar bith? / Are there any medications that your child is allergic to and/or must not be prescribed?
Yes
No
Clear selection
An bhfuil ailléirge ar bith ag do pháiste? / Does your child have any allergies?
Yes
No
Clear selection
An bhfuil riachtanas cothaithe ar leith ag do pháiste? / Has your child any special dietary requirements
Yes
No
Clear selection
Má thug tú freagra dearfach do ceist ar bith thuas tabhair mioneolas anseo le do thoil nó má tá fadhb shláinte eile ag do pháiste a mbíonn cogas uaidh nó uaithi, nach bhfuil luaite thaus, tabhair eolas anseo le do thoil. / If you answered 'Yes' to any of the above, please give details below or if your child has a medical condition not mentioned above and requires medication please give the details below.
Your answer
Deimhním go bhfuil an t-eolas sláinte atá thugtha anseo i gceart. Tuigim go ndéanfar tréan iarracht teagmháil a dhéanamh liom má tá mo pháiste ar lorg leighis práinneach (nó leis an Uimhir Fóin eile i gCás Éigeandála muna a bheas mé ar fáil) ag na huimhreach atá tugtha san fhoirm seo. Má éiríonn mo pháiste tinn nó má tá sé/í gortaithe i rith an club seo (2022-2023), aontaim go gtugfar cuirim leighis práinneach máinliach nó déadach a bheas riachtanach dó/di, sa chomhthéacs nach féidir teagmháil a dhéanamh liom chun cead a thabhairt ag am cóir leighis. Má aontaíonn tú leis seo, scríobh d'ainm thíos le do thoil: / I confirm that the medical details in relation to my child are correct. I understand that in the event of my child requiring medical attention all reasonable efforts will be made to contact me (or the Alternative Emergency Contact if I am un-contactable) at the contact numbers provided on this consent form. In the event of my child being taken ill or injured during the period of the club óige (2022/2023), I consent to any emergency medical, surgical or dental treatment that may be necessary in a situation where I cannot be contacted for the purposes of giving consent at the time of treatment. If you agree, please write your name:
Your answer
Scríobh dáta den lá atá inniu ann le do thoil: / Please write today's date:
MM
/
DD
/
YYYY
Please note that Glór Uachtar Tíre’s Child Protection and Vulnerable Adult Policy is available on our web site at
www.gloruachtartire.com
Cead chun Grianghraif nó Físeán Gairid a Ghlacadh fá choinne Fáthanna Réamhfhógraíochta Amháin / Permission to Take Photographs or Short Videos for Promotional Purposes Only
An dtugann tú cead go nglacfar grianghraif de do pháiste nó go mbeidh do pháiste páirteach i bhfíseán gairid i rith Club Óige? Tabhair faoi deara, le do thoil, go mbainfear úsáid as na grianghraif is físeán siúd le haghaidh cúiseanna réamhfhógraíochta Ghlór Uachtar Tíre amháin. Ní tabharfar iad do ghrúpa nó dhuine eile ar bith. / Are you are willing for your child to have their photo taken or to be included in short videos during the Club Óige? Please note that these photos shall only be used for Glór Uachtar Tíre’s promotional activities. They will not be forwarded on to a third party.
Yes
No
Clear selection
Ag fágáil an Chlub Óige agus Polasaí faoi Filleadh Abhaile / Departing the Youth Club and Homeward Policy
Roghnú cén socrú atá is fóirsteanaí duit le haghaidh do pháite agus é/í ag fágáil an Chlub Óige le dul abhaile. / Please select which option suits you best for your child when departing the youth club:
Wait by themselves
Make their own way home
Neither (please write the arrangements to ensure your child returns home safely)
Clear selection
Má scríobh tú 'Neither' thuas, inis dúinn anseo le do thoil cén dóigh a rachaidh do pháiste abhaile. / If you answered 'Neither' above, please write the arrangements to ensure your child returns home safely.
Your answer
Turais agus Imeachtaí / Trips and Outings
Tabhair faoi deara le do thoil nach mbeidh an Club Óige in ann leanúínt le turais muna a bheas ar a laghad 8 mball den Chlub páirteach iontu. / Please note that trips and outings will not be able to go ahead unless at least 8 members of the Youth Club attend.
Go raibh míle maith agat. Tá muid ag dúil le sibh uilig a fheiceáil ag Club Óige 2022/2023. / Many thanks. We're looking forward to seeing you all at the Club Óige 2022/2023.
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