Camino for Clionas Application form

Student Information

Student Name*

Name as per passport (if different)

Date of Birth*

Address

Street Address*

Town / City*

Eircode*

Student Mobile Number*

Student Email address*

Parent/Guardian Information

Parent/Guardian Name*

Relationship (parent/guardian)*

Parent/Guardian Mobile Number*

Parent/Guardian Email*

School Information

Name of School*

Principal*

Name of TY Coordinator*

Medical Information

GP Name*

GP Phone*

Allergies (if any)

Medical Conditions (if any)

Medication (if any)

Dietary Requirements (if any)

Parental Consent

Do Cliona’s School team have your permission to include your son/daughter in our communications with you regarding the programme and trip throughout the year? *

Yes

No

Do Cliona’s School team have permission to add you, the parent/guardian, to a WhatsApp group with all parents/guardians from your child’s school?*

Yes

No

Do you give photo permission for your child and for these photographs to be used for social media/PR purposes?*

Yes

No

Upload a photo or scan of the picture page of the students passport*

Accepted formats: jpg, png, pdf Max file size: 4MB

GDPR Consent*

As the parent/guardian I consent to Cliona's using the information provided in this form solely for the purposes of processing this application, in accordance with our Data Protection Policy

This field should be left blank