Enrollment Clontarf

Details about the child

Name:*

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Nationality:*

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Class/Grade*

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PPS Number

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Date of Birth: *

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Start Date:*

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Teacher’s Name*

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Gender:*

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School Attending*

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Languages spoken at home*

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Collection from School Required?*

Yes

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If yes, name of responsible person: *

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Approx Collection Time:*

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Approx Pick-up Time from Afterschool*

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Parent/Guardian information

Parent/Guardian Full Name:*

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Relationship to Child:*

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Address:

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Contact information

Phone:*

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Work phone number:*

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Email:*

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Emergency Contact Information (Other than Parent/Guardian)

Parent/Guardian Full Name:

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Name:*

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Name:*

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Name:

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Phone:

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Relationship to Child:*

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Relationship to Child:*

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Relationship to Child:

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Email:

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Phone:*

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Phone:*

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Phone:

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Medical Information

Doctor Name:

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Medical conditions and allergies:

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Doctor's phone number:

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Medications currently taken (days and time):

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Medication during Afterschool? (authorisation form required)*

Yes

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Additional Needs/Supports*

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Individual Care/Support Plan?*

Yes

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Emergency Medical Consent:*

I consent to emergency treatment

I consent to first aid

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Signature:*

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Date:*

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

Full Name:

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Relationship:

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Phone:

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Special Instructions or Notes

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School Information

Child's School*

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

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Class/Year:

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

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Other Comments:

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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

Complaints

Drop-off & Collection

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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.

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

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ENROLLMENT FORM FOR Clontarf - Dublin 3

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

Parent/Guardian information

Contact information

Emergency Contact Information (Other than Parent/Guardian)

Medical Information

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

School Information

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

Policies Acknowledgement

Data Protection (GDPR)

ENROLLMENT FORM FOR Clontarf - Dublin 3

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

Parent/Guardian information

Contact information

Emergency Contact Information (Other than Parent/Guardian)

Medical Information

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

School Information

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

Policies Acknowledgement

Data Protection (GDPR)

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.

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