BDY print – Dundrum Parish

PARENT/GUARDIAN & CHILD JOINT CONSENT 2025/26

Parish Name: Dundrum Address: Holy Cross Church, Main Street, Dundrum, Dublin 14

1.0 Data protection This form will be held on file, in accordance with the data protection policy the Archdiocese of Dublin. The data entered will be used only for the purpose indicated on the form. may only be essed with responsibility for managing records or group activities.

2.0 Group details

Name of group: Dundrum/Ballinteer/Meadowbrook Parishes Faith Youth Club - BDY

Activity details: Faith Youth Club - Dundrum Pastoral Centre, Holy Cross Church.

Duration of activity Every second Friday from 7pm to 9pm

Name of organiser: Dundrum Parish - BDY Contact Parent - Tarny Reilly – 087 2627424

3.0 Details of the child/young person

Name of young person

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Date of birth

Gender

Male
Female

Other relevant information

(Please mention any medical conditions, special needs. dietary requirements). Please note that the organisers cannot administer any medication. Should your child require medication intimater please discuss this with the organisers who will work with you to establish how your child can be accommodated, according to relevant policies and procedures.

5.0 Parent/Guardians contact details.

Name

Mobile number

Address (copy)

Address Line 1

City

State / Province / Region

Postal Code

Country

Email

Contact information for emergency use only

(if different from the information given above)

6.0 In cases of a medical emergency

In the event of illness or an accident, I give permission for medical treatment to be administered to my child, where considered necessary, by a suitably qualified medical practitioner and/or hospital. I understand that every effort will be made to contact me as soon as possible. In an emergency I can be contacted at the telephone numbers provided

Signed

7.0 Child's/young person's consent

(insert full name) would like to take part in the event listed.

Tick the boxes below

I understand that group photographs may be taken during the group activities, and I give my permission for these to be used in any hard copy/online (delete as appropriate) publications by Dundrum/Ballinteer/Meadowbrook Parishes.
I understand that during group activities I will be appropriately supervised at all times and will agree to abide by the group's code of behaviour.

8.0 Parent/Guardian's consent

I agree to allow the above-named child/young person to attend meeting of BYDat the times and dates stipulated in section 2.0 in accordance with the permission granted by

(insert name of child/young person)

I understand that there will be suitable supervision and an agreed code of behaviour while the children/young people are in the care of the organisers.

Parent/(Guardian)

Child/young person

Relationship to child/young person