Coderdojo Member Registration and Parental Permission Form

Coderdojo Member Registration and Parental Permission Form

For any members under 18, parent/guardian contact details are required to be provided to meet Child Protection and Health and Safety requirements. It is also important to note that members aged 12 and under are required to have a parent, guardian, or nominated adult remain on-site during Coderdojo sessions.

This form must be filled out and returned to for registration.

Coderdojo Location: CORK – CIT BLACKROCK CASTLE OBSERVATORY

Date of CoderDojo Session: ______

Attendee first name: ______

Attendee surname: ______

Attendee date of birth(DD/MM/YYYY): ______

Medical conditions: ______

______

Please list any medical conditions that Coderdojo mentors should be aware of in the event of illness or accident. Please note that if the member needs to take medication during the time of Coderdojo sessions, it is their/guardian responsibility to ensure this happens.

PARENT DETAILS

If you are over 18, please complete remaining sections with your own information or appropriate contact information in the case of emergencies.

Parent first name: ______

Parent surname: ______

Parent contact email: ______

Parent Contact Number 1:______

Coderdojo requires 2 contact numbers to be provided to ensure contact can be made in case of emergencies.

Parent contact number 2: ______

Help at Coderdojo sessions? YES / NO

We appreciate everyone (of any age) who can donate their time and expertise to Coderdojo. We are not just looking for those with IT skills but any adults who are willing to undergo Garda vetting so that supervision of the bigger groups is made easier is greatly appreciated.

Skillset - Please list any skills you would like to share at Coderdojo

______

Permission Slip

We ask your permission for your child to participate in certain activities. Please read carefully each of the items below and mark yes or no. If you have any concerns regarding any of the items below please feel free to contact mentors of your Coderdojo group.

I hereby give permission for my child in relation to the following:

Leaving Coderdojo location YES/NO

Leaving Coderdojo location at break time during sessions. Please note this is only applicable to children aged 13 and over.

Club activities –YES/NO

Going on local educational visits/field trips and participating in club activities (e.g. coding competitions, seminars etc.)

Media- Pictures and names appearing in local/national media – YES/NO

Do you agree to Coderdojo/CIT Blackrock Castle Observatory using your child’s image in this way? On occasions where Coderdojo and CIT Blackrock Castle Observatory may be featured in the press and media, local press photographers may take group photos of club members and in some instances identify the children by name. (Your child will always have the right not to stand in for a photo if they are uncomfortable with appearing in local press).

CoderDojo/BCO website- Images and names appearing on Coderdojo/BCO website – YES/NO

Do you agree to Coderdojo/BCO using your child’s image in this way? It is Coderdojo’s and BCO’s policy to celebrate your child’s work and achievements. As a result, images of your child and his/her work may appear on our website. Usually children will only be pictured at a distance and in groups.

Emergencies

Do you give permission for your child to be taken immediately to a doctor or hospital in case of serious illness/accident? YES/NO