City Kids Registration Child's InformationChild's name(Required) First Last Child's date of birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's school class Please give any relevant information concerning your child's health, declaring any known medical conditions, allergies, and medications which he/she is currently receiving.Please specify any dietary requirements that your child has.Please outline any other appropriate information that would be helpful for the children's leaders to know, including if your child has any additional needs.I give permission for my child to receive a snack during City Kids.(Required) Yes No I give permission for a leader to bring my child to the toilet(Required)The leader will walk your child to the toilets and wait outside the facility. If your child requires assistance using the toilet, please select no. Yes, my child is toilet-trained and I am happy for a leader to walk my child to the toilet No, I wish to be called should my child need the toilet I give permission for photographs/video to be taken of my child while involved in City Church Dublin activities.(Required)Consent may be withdrawn at any time. Yes No I consent to City Church Dublin using appropriate images of my child for social media, hardcopy, and/or online publications. These may also be retained for continued use.(Required) Yes No Parent/ Guardian InformationParent's / Guardian's full name(Required) First Last Relation to child(Required) Contact number(Required)Email(Required) Enter Email Confirm Email I consent to receiving emails from City Church Dublin(Required)You can unsubscribe at any time Yes No Address(Required) Street Address Address Line 2 City Eircode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands ConsentI confirm that I have given my consent for my child to attend the children's programmes at City Church Dublin ("City Kids" / "City Toddlers")(Required) Yes I will inform City Church Dublin if any of the information concerning my child changes(Required) Yes Parent's / Guardian's Signature(Required)Date signed(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Data consent(Required) I agreeIn accordance with General Data Protection Regulations, we are committed to protecting the personal information given on this form. By providing this information, you are giving us permission to use it for Safeguarding, legal or regulatory purposes and we will use it for no other purpose without further consent unless mandated or required to do so under the Data Protection Act 2018 or equivalent legislation. If you have any questions about how we process your personal data, please contact a member of the Panel. This information is kept indefinitely (as it relates to children) on an external hard drive in a locked cabinet. Information necessary for leaders (including parental contact details) is kept on hand at the Odeon. If you wish to access the information held about your child/ren at any point, please contact Sarah Mitchell or the City Church Dublin Safeguarding Panel. You can find more info in our Privacy Policy https://citychurchdublin.ie/privacy-policy and our Safeguarding Policy https://citychurchdublin.ie/families/safeguarding Δ
