This form is to be signed by a parent/guardian and school of any child under 18 who has been offered a place on TY Academy, our work experience programme. The programme takes place in Concern’s offices on Camden Street, Dublin between 10am-3.30pm.

As part of this programme, we also offer students the chance to attend our end of year celebration day, Agents of Change which takes place on May 10th 2023, 10am – 3pm.

Please Lauren Wright, Schools Programme Officer, if you have any questions on schools@concern.net

TY Academy 2022: Student Consent Form

1: Young person's details

Student name (required)

School name (optional)

Date of work experience (optional)

2: Parent or guardian's details

Name of parent/guardian (required)

Emergency contact number (required)

Contact email address (required)

3: Information we need to know

This information is to ensure that the week is safe and inclusive for all students.

We may provide snacks during the week. Are there any allergies or dietary needs that we need to be aware of? (required)

Are there any medical conditions that we need to be aware of? (required)

Are there any additional educational needs that we need to be aware of? (required)

Are there any access requirements that we need to put in place? (required)

Core purpose (please tick to indicate consent) (required)

I confirm that the student named has permission to attend TY Academy Monday to Friday the week they have signed up to

I confirm that I give permission for them to attend our end of year celebration event, Agents of Change on May 10th 2023 at Smock Alley Theatre and other follow up events (TBC)

I confirm that I give permission for them to leave the office/event during lunch time (if no consent given a packed lunch will need to be provided each day)

I confirm that I give permission for Concern to use photographs/video footage of my child taken at TY Academy/Agents of Change on our website, social media or school resources produced by the Active Citizenship team

I confirm that I give permission for my child to be contacted by the Active Citizenship team about the programmes/events (parents/guardians are always cc'd in)

I confirm that I give permission for the student named above to receive Concern Active's Youth E-Newsletter

4: For the young person to complete

Over the course of the next week you will be doing a number of different activities to give you a taste of what it is like to work for Concern Worldwide. This will involve meeting Concern staff and taking part in group work with other young people on the programme.

I agree to: (required)

Taking part in TY Academy and Agents of Change

Concern keeping a record of this form so they have the information they need to keep me safe during the activity

To receive the Concern Youth E-Newsletter

Being filmed/photographed during the activity. I understand that the photographs or films may be used to tell other people about what (name of group/organisation) does.

Signature of Parent/Guardian (required)

Concern processes this personal data for the specific purposes described and based on the student’s and parent’s/guardian’s consent which can be withdrawn at any time without affecting Concern’s use prior to that withdrawal. For more information on Concern’s commitment to data protection, your rights and contact information, please visit our privacy policy at www.concern.net/about/privacy

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Concern Worldwide, a company limited by guarantee, Registered Company Number: 39647, Registered Revenue Number: CHY 5745,
Registered Charity Number: 20009090, Registered in Ireland, Registered address is 52–55 Lower Camden Street, Dublin 2.
Phone: +353 1 417 7700