Membership Registration 2025/2026

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* 1. Name of Group Registering for

Clondalkin Localise (Monday's 6-7pm, meeting at Clondalkin Parish)

Castleknock Localise (Friday's 7:00-8:00pm, meeting at Castleknock Parish)

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* 2. Full Name of Young Person

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* 3. Young Person's Date of Birth

Please enter valid date.

Date

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* 4. School

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* 5. Class/Year in School

5th Class

6th Class

1st Year

2nd Year

3rd Year

4th Year

5th Year

6th Year

Currently not in education

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* 6. Address

Address

Address 2

City/Town

County

Eir Code

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* 7. Contact Details of Parent/Guardian

Name

Email Address

Phone Number

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* 8. If you are happy for your young person to receive information on Localise meetings and events via text and/or email please fill in their information.

Email Address

Phone Number

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* 9. Contact details of Family Doctor

Name

Phone Number

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* 10. Does your young person have any allergies? If so, what?

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* 11. Does your young person have any special dietary requirements we should be aware of?

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* 12. Does your young person have any medical conditions we should be aware of?

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* 13. In the event of an accident, I give consent for my young person to receive First Aid

Yes

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* 14. Photos and video may be taken during Localise Community Service Events and meetings for the Localise Virtual Service Projects, scrapbook, our website, our social media platforms, or the occasional poster and promotional material.

(NB: No Localise member is entitled to take unofficial video, photographic or audio footage of any Localise events or meetings and/or to use these videos or recordings on private/personal social media accounts.)

Please indicate by ticking the appropriate box whether you and your young person have had spoken about this consent and both agree to give your permission for such photographs/video of your young person to be used as described above:

Yes

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* 15. I will collect my young person after Localise meetings/events.

Yes

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* 16. Should I (the parent(s)/guardian(s)) not be available to collect my young person, the nominated person(s) below may do so on my behalf.

Name

Relationship to Young Person

Phone Number

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* 17. I give my child permission to make their own way home after the meeting.

Yes

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* 18. By selecting "Yes", I give permission to my young person, to attend the Localise Programme and its associated activities. I understand that the granting of membership is subject to members following all rules and procedures. Failure to do so could result in partial or full suspension from the programme.

Yes