Coderdojo Athlone Member Registration and Parental Permission Form
This is the contact details form for Coderdojo Athlone members.

For any members under 18, parent/guardian contact details are required to be provided to meet Child Protection and Health and Safety requirements. It is also important to note that members aged 12 and under are required to have a parent, guardian, or nominated adult remain on-site during Coderdojo sessions.

On submission of this form, the completed details will be emailed to the address provided. This email must be printed, signed by parent/guardian, and brought to the next Coderdojo session attended.

Coderdojo Location *
Pick the Coderdojo you will most often attend
Attendee first name *
Your answer
Attendee surname *
Your answer
Attendee date of birth *
Please enter date in DD/MM/YYYY format
Your answer
Medical conditions *
Please list any medical conditions that Coderdojo mentors should be aware of in the event of illness or accident. Please note that if the member needs to take medication during the time of Coderdojo sessions, it is their/guardian responsibility to ensure this happens.
Your answer
If you are over 18, please complete remaining sections with your own information or appropriate contact information in the case of emergencies.
Parent first name *
Your answer
Parent surname *
Your answer
Parent contact email *
Your answer
Parent contact number 1 *
Coderdojo requires 2 contact numbers to be provided to ensure contact can be made in case of emergencies.
Your answer
Parent contact number 2 *
Your answer
Help at Coderdojo sessions? *
We appreciate everyone (of any age) who can donate their time and expertise to Coderdojo. We are not just looking for those with IT skills but any adults who are willing to undergo Garda vetting so that supervision of the bigger groups is made easier is greatly appreciated.
Please list any skills you would like to share at Coderdojo
Your answer
Permission Slip
We ask your permission for your child to participate in certain activities. Please read carefully each of the items below and tick the relevant box. If you have any concerns regarding any of the items below please feel free to contact mentors of your Coderdojo group.

I hereby give permission for my child in relation to the following:

Leaving Coderdojo location *
Leaving Coderdojo location at break time during sessions. Please note this is only applicable to children aged 13 and over.
Club activities *
Going on local educational visits/field trips and participating in club activities (e.g. coding competitions, seminars etc.)
Media *
Pictures and names appearing in local/national media. Do you agree to Coderdojo using your child’s image in this way? On occasions where Coderdojo may be featured in the press and media, local press photographers may take group photos of club members and in some instances identify the children by name. (Your child will always have the right not to stand in for a photo if they are uncomfortable with appearing in local press).
Coderdojo website *
Images and names appearing on Coderdojo website. Do you agree to Coderdojo using your child’s image in this way? It is Coderdojo’s policy to celebrate your child’s work and achievements. As a result, images of your child and his/her work may appear on our website. Usually children will only be pictured at a distance and in groups.
Emergency *
Do you give permission for your child to be taken immediately to a doctor or hospital in case of serious illness/accident?
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