Campette's Date of Birth:*
---12345678910111213141516171819202122232425262728293031---JanFebMarAprMayJuneJulyAugSeptOctNovDec---200220032004*Please note: Campette must be ages 11,12 or 13 at 1st July 2015 to attend this camp. Proof of age may be requested at Camp.
Campette's age at 1st July 2015:* * Campettes age at 1st July 2015.
Summer camp of choice:*
Jersey sizes:* ---Age 9/10Age 10/11Age 136810121416182022Mens SmallMens MediumMens LargeMens X-Large* Please note: these are O'Neill's sportswear sizes. We will do our best to give Campettes their preferred jersey size, or that closest to it. However, this is not guaranteed.
Has your daughter been to Camp before? * ---YesNo
If so, please select which Camp: ---Antrim: BelfastArmagh: CloughreaghDerry: MagheraDonegal: LetterkennyDown: NewryDublin: RathminesFermanagh: EnniskillenKildare: MaynoothMayo: KnockMonaghan: ClonesTyrone: GlencullTyrone: Omagh
Please state the name of ONE other Campette you would like to be in your Campette's group at Camp? * Please note it is not always possible for us to place friends together.
Parent/Guardian's Postcode (if ROI put N/A):*
Parent/Guardian's Contact number:*
Parent/Guardian's Mobile number:*
Parent/Guardian's E-mail Address:*
Confirm Parent/Guardian's E-mail Address:*
Please note: Please take care when submitting your e-mail address as this will be used as a primary point of contact.
Name of person responsible for the Campette in the event of the parent / guardian being unavailable:*
Relationship with child:*
Responsible Adult contact number:*
* = Required field
Does your Campette have any allergies? * ---YesNo
If so, please state what:
Does your Campette use regular medication? * ---YesNo
I grant my consent for Michaela Foundation to seek medical care for my Campette in case of an emergency: * ---YesNo
Is there anything else you wish to tell us about your Campette’s health and/or wellbeing? :
Do you grant consent for Michaela Foundation to take photos/videos of your Campette whilst at camp, for promotional purposes only? * ---YesNo
Does your daughter (the Campette) grant permission for Michaela Foundation to take her photo whilst at camp, for promotional purposes only? * ---YesNo
Michaela Foundation's Imaging Policy and Guidelines
Campette's level of Irish language: * ---Has not learned Irish beforeBeginnerIntermediateAdvancedFluent
Where did you hear about Camp? (Only select one):* FacebookTwitterMichaela Foundation WebsiteSchoolRadioChurchCommunity ClubNewspaperFriend / FamilyMichaela Foundation Team Member / VolunteerOther
If other, please state where :
To be completed by the Campette and their Parent / Guardian
Do you and your Campette agree with and accept Michaela Foundation’s Code of Conducts for parents/guardians and Campette’s?
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