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Enrollment form for Ardee

Ardee

Program:

Afterschool and Breakfast Club
School:

Ardee Educate Together
Address:

National School, Jervis Street, Ardee, A92 R5FK
Days:

Monday - Friday
Time:

Before and after school
Age:

4 to 12 years old

When completing the interest form, your child will be enrolled to our After School Program.

To enroll in the After School Program, parents will be required to pay the Registration Fee + first month.

Details about the child

Name:*

Tell us your name :)

Nationality:*

Tell us your nationality :)

Class/Grade*

Please fill in this field

PPS Number

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Date of Birth: *

Please fill in this field

Start Date:*

Please fill in this field

Teacher’s Name*

Please fill in this field

Gender:*

Enter the gender

School Attending*

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Languages spoken at home*

Please fill in this field

Collection from School Required?*

Yes

No

Please fill in this field

If yes, name of responsible person: *

Please fill in this field

Approx Collection Time:*

Please fill in this field

Approx Pick-up Time from Afterschool*

Please fill in this field

Parent/Guardian information

Parent/Guardian Full Name:*

Please fill in this field

Relationship to Child:*

Please fill in this field

Address:

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Contact information

Phone:*

Could you give us your phone number?

Work phone number:*

Could you give us your work phone number?

Email:*

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Emergency Contact Information (Other than Parent/Guardian)

Parent/Guardian Full Name:

Please fill in this field

Name:*

Please fill in this field

Name:*

Please fill in this field

Name:

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Phone:

Could you give us your phone number?

Relationship to Child:*

Please fill in this field

Relationship to Child:*

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Relationship to Child:

Please fill in this field

Email:

I think there's something wrong with your email.

Phone:*

Could you give us your phone number?

Phone:*

Could you give us your phone number?

Phone:

Could you give us your phone number?

Medical Information

Doctor Name:

Please fill in this field

Medical conditions and allergies:

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Doctor's phone number:

Could you give us the doctor's phone number?

Medications currently taken (days and time):

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Medication during Afterschool? (authorisation form required)*

Yes

No

Select an option

Dietary Needs: *

Vegetarian

Vegan

Halal

Kosher

Gluten-Free

Other

Select an option

Please fill in this field

Additional Needs/Supports*

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Individual Care/Support Plan?*

Yes

No

Select an option

Emergency Medical Consent:*

I consent to emergency treatment

I consent to first aid

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Signature:*

Please fill in this field

Date:*

Please fill in this field

Authorized Pick-up Persons (Other than Parent/Guardian)

Full Name:

Please fill in this field

Relationship:

Fill in this field.

Phone:

Could you give us your phone number?

Special Instructions or Notes

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School Information

Child's School*

Please fill in this field

Pick-up Time from Child's School (if applicable)

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Class/Year:

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After School:*

Monday

Tuesday

Wednesday

Thursday

Friday

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Permissions
Authorization for Child's Photo/Video Release on Peter Pan Social Media

Selecione um assunto válido.

Other Comments:

Digite a sua mensagem

Permissions:

I consent for staff to administer basic first aid.

I consent for staff to call an ambulance/doctor in case of emergency.

I consent for my child to go on local outings/walks.

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Policies Acknowledgement

I have read and understood the service’s policies, including:*

Behaviour Management

Drop-off & Collection

Please select in this field

Data Protection (GDPR)

We collect and store your child’s personal data in line with GDPR requirements. This information will only be shared with Tusla or other relevant authorities where legally required*

I consent to the collection and processing of my child’s data for afterschool care.

Please select in this field

By submitting this form, you agree to the terms of the website's Privacy Policy.

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