Clárú/Registration: GAISCE Award 2023-'24
Tá Glór Uachtar Tíre, grúpa Gaeilge an phobail, Caisleán Uidhilín, ag eagrú Gaisce i rith 2023-'24. Tabhair faoi deara go gcaithfidh duine atá freagracht tuismitheoirí acu an fhiorm seo a líonadh isteach.
Castlewellan's Irish language community group, Glór Uachtar Tíre, is coordinating Gaisce/The President's Award throughout 2023-'24. Please note that this form must be completed by a person with parental responsibility for the young person.

Contact Details and more information: gloruachtartire@hotmail.co.uk; 07501 252027
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Ainm/Name
Ainm Meánscoile atá tú ag freastail/ School you attend
Bliain scoile / Your school class year ie Bliain 11,12, 13, 14:
Tugaim cead do mo pháiste a bheith páirteach i ngach imeacht a bheas ar siúl i rith an chlár Ghaisce. Aontaim agus Deimhním go mbeidh údarás ag an dhuine atá i mbun imeachtaí Ghaisce 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 the Gaisce programme. I authorise and agree that the persons running the Gaisce activities 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:
Seoladh ríomhphost an thuismitheora/ Parent's email address
Uimhir fóin an thuismitheora/ Parent's phone number
Uimhir Fóin eile i gCás Éigeandála / Alternative Emergency Contact Number:
Cén baint atá ag an duine seo le do pháiste?/ Relationship of owner of emergency contact number to your child?
Eolas Sláinte agus Cead Leighis / Medical Details & Medical Consent Form
Ceisteanna Sláinte Ginearálta / General Medical Questions:
An bhfuil tinneas tromchúiseach ag do pháiste? / Has your child any serious illnesses?
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An bhfuil ailléirge ag do pháiste do penicillin? / Is your child allergic to penicillin?
Clear selection
An nglacann do pháiste cógas go rialta? / Does your child take any regular medication?
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?
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An bhfuil ailléirge ar bith ag do pháiste? / Does your child have any allergies?
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An bhfuil riachtanas cothaithe ar leith ag do pháiste? / Has your child any special dietary requirements
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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.
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 imeachtaí ar an chlár Ghaisce,  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 activities in the Gaisce programme, 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:
Scríobh dáta den lá atá inniu ann le do thoil: / Please write today's date:
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DD
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YYYY
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 an chlár Ghaisce? 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 Gaisce programme? 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.
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Go raibh míle maith agat. Tá muid ag dúil le Gaisce a eagrú go háitiúil/ Many thanks. We're looking forward to coordinating Gaisce locally.
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