Home
Information Centre
COVID19 Level5
Domestic Violence and Abuse Guidance
Ballincollig Supports and Contacts
Seniors, Cocooning and Isolating
Keeping Kids Occupied?
General Links
Tusla Update
Services
Pre-School
Virtual Pre-School
Employment Supports
Family Support
Health and Wellbeing
Community Support
Drug & Alcohol Project
Employment Supports
Creating Community Alternatives
Community Volunteering
Events
Classes
Art Classes
Horticulture Classes
Groups
Job Vacancies
Forms
Volunteer Application Form
Early Years Pre-school Application
Homework Club Application
About
Ballincollig Family Resource Centre (FRC)
Home
Information Centre
COVID19 Level5
Domestic Violence and Abuse Guidance
Ballincollig Supports and Contacts
Seniors, Cocooning and Isolating
Keeping Kids Occupied?
General Links
Tusla Update
Services
Pre-School
Virtual Pre-School
Employment Supports
Family Support
Health and Wellbeing
Community Support
Drug & Alcohol Project
Employment Supports
Creating Community Alternatives
Community Volunteering
Events
Classes
Art Classes
Horticulture Classes
Groups
Job Vacancies
Forms
Volunteer Application Form
Early Years Pre-school Application
Homework Club Application
About
Forms
Homework Club Application
Homework Club Application Form
Child Details
Gender
Male
Female
Surname
Forename
Date of Birth
Home Address
Email (All notices will be sent by email)
Parent's Native / First Language
Age of Child (commencing in September)
Class child is attending in September
Days your child wants to attend
Monday
Tuesday
Wednesday
Thursday
Parent/Guardian(s) Contact Details
Name
Address
Daytime Contact No(s)
Mobile Number
Relationship to Child
Name
Address
Daytime Contact No(s)
Mobile Number
Relationship to Child
You must be contactable at these numbers during the time your child is attending the Homework Club, if not please give us a number that we can contact someone in the event of an emergency
Name of Emergency Contact person
Mobile Number
Relationship to Child
Personal Details
Doctor's Name /Contact No
Address
Does your child have any medical conditions, illness, disabilities and / or allergies?
Yes
No
Please outline details and special requirements if any
Does your child have any specific dietary requirements?
Have any of your child's siblings / relations attended Ballincollig Family Resource Centre Pre-School / Homework Club in the past?
Yes
No
If yes, please provide names and details of attendance
_________________________________________________________________________________________________________
During the course of the year we may gather images digital or otherwise of the Homework Club for use in reports (Annual Report) or Facebook, our website or any advertising / promotion
Do you give your permission
Yes
No
In the case of an emergency Ballincollig Family Resource Centre may need to deal with the situation immediately. Your consent is required to act on your behalf. You will be asked to sign when you visit the Centre.
Please note there is currently a waiting list for the Homework Club. We will contact you when a place becomes available and invite you to come and meet us and sign additional paperwork.
Please enter the code:
The
Privacy Policy
applies.
Note:
Please fill out the fields marked with an asterisk.
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