This form is to be signed by a parent/guardian and school of any child under 18 who is attending an event ran by the Active Citizenship team. This must be completed and signed by the parent/guardian.

Important information:

· Events run from 10am to 3pm on their designated days.

· Please note, snacks maybe provided but lunch isn’t.

· If you do not give permission for the young person to leave the location then they must bring a packed lunch

Please contact Lauren Wright, Schools Programme Officer, if you have any questions on schools@concern.net Please contact debates@concern.net for any questions related to the debate events/programme

STUDENT EVENT: Student Consent form

1. Young person's details:

Student name (required)

School name (required)

Please tick to indicate which event the young person is attending: (required)

Student Kick-off Event – 30th Sept at Temple Bar Gallery, Dublin

World Food Day Event – 13th Oct at Concern Worldwide Office, Dublin

International Day of Education – 24th January at Concern Worldwide Office, Dublin

International Women’s Day – 8th March at TBC

Agents of Change – 27th April at Smock Alley Theatre, Dublin

Concern Debates Student Training CORK - 5th Oct at University College Cork

Concern Debates Student Training DUBLIN - 11th Oct at Temple Bar Gallery, Dublin

Concern Debates Student ONLINE Training - Thursday 6th October 1-2 PM

Concern Debates Student Training Dublin - 12th Oct - Venue TBA

2. Parent or guardians details:

Name of parent/guardian (required)

Emergency contact number (required)

Contact email address (optional)

3. Information we need to know

We may provide snacks during the event. 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 education 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 about has permission to the indicated event(s) above

I confirm that I give permission for them to leave the event during lunch time to get lunch off site (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 the event(s) on our website, social media or schools resources produced by the Active Citizenship team

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

If yes, please provide student email for newsletter: (optional)

For the young person to complete

I agree to: (required)

Attend and take part in the indicated event(s)

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

Receiving the Concern Youth E-Newsletter

Being filmed or photographed during the activity. I understand that the photographs or film might be used to tell other people about what [name of group/organisation] does. (We will always ask on the day before we take photographs so you can decline then

Note: If I don’t agree to this Concern will not use any images of me.

Parent/guardian's signature (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