FOIRM IARRATAIS APPLICATION FORM - UISCE

FOIRM IARRATAIS APPLICATION FORM
PLEASE WRITE CLEARLY USING BLOCK CAPITAL LETTERS
Uimhir thagarthA
AINM / Name _________________________________________________________________________ ☐ BUACHAILL / Boy ☐ CAILÍN / Girl
AINM AS GAEILGE __________________________________________________________________________________________________________
SEOLADH / Address _______________________________________________________________________________________________________
SEOLADH GAEILGE / Address in Irish ______________________________________________________________________________________________
RÍOMHPHOST SCOLÁIRE / Student’s Email __________________________ FÓN PÓCA SCOLÁIRE / Student’s Mobile ________________________________
DÁTA BREITHE / Date of Birth ____________________ AOIS / Age (12 -19) _________________ FÓN / Telephone _______________________________
TUISTÍ / Guardian Name _________________________________________ RÍOMHPHOST NA dTUISTÍ / Guardian’s Email ______________________________
FÓN PÓCA NA dTUISTÍ / Guardian’s Mobile ________________________ AIFREANN / Do you wish your child to attend religious services (RC)? ☐ No ☐ Yes
CÚRSAÍ SLÁINTE / Health Issues / Allergies / Special Requirements (See note 5) No ☐ Yes ☐ If yes please specify ____________________________________
______________________________________________________________________________________________________________________
BIA / Special Dietary Requirements or food allergies ________________________________________________________________________________
SNÁMH / Can you swim? ☐ No ☐ Weak ☐ Greater than 25m
TAITHÍ SNA hEACHTRAÍ UISCE / Water Sport Qualifications (give details) ______________________________________________________________________
Name and phone number of person responsible in the event of your parent / guardian being uncontactable _________________________________________________
_____
SCOIL / SCHOOL
RANG / Class (Next School Year) 6th Class - 6th Year ___________________________ BLIAIN NA hARDTEISTE / Year of Leaving Cert ______________________
SCRÚDÚ GAEILGE / Your Next State Exam (Gaeilge) ☐ None ☐ Jr. Cert (Ord) ☐ Jr. Cert. (Hon) ☐ Leaving Cert (Ord) ☐ Leaving Cert (Hon)
AINM & SEOLADH SCOILE / School Name & Address __________________________________________________________________________________
MÚINTEOIR GAEILGE / Irish Teacher _____________________________________________________________________________________________
Eagraí Idirbhliana / Transition Year Co-ordinator __________________________________________________________________________________
Please place my child in a class according to (please select one only): ☐ Personal Standard of Irish ☐ Friend’s Standard of Irish / Friends Attending
FADHBANNA FOGHLAMA / Specific Educational Needs (See note 5) ☐ No ☐ Yes (Sonraí/Give details) ____________________________________________
Have you previously attended a Gaelscoil ☐ No
☐ Yes (Sonraí/Give details) ___________________________________________________________
COLÁISTE UISCE
UISCE CHEANA / Have you attended UISCE previously?
☐ No ☐ Yes What year? _____________
How did you hear about Coláiste UISCE?
☐ Attended Previously ☐ Television ☐ Teacher / School
☐Friend / Family ☐ Internet ☐ Radio ____________
☐Show / Event ___________________ ☐Other _____________
Coláiste UISCE
☐ Cásc / Easter ☐ Cásc Diansraith
☐ A
☐ B
☐ C ☐ C Level 2 in: ___________
☐ D
☐ E ☐ E Diansraith
☐ F
UISCE Skills Courses
☐ Instructors: ____________
☐ Skills: ________________
☐ Other: ________________
Youth Leadership Courses
☐ Level 1 (u16)
☐ Level 2 (16+)
☐ Level 3 (17+)
LÓISTÍN / ACCOMMODATION
Accommodation preference ☐ No preference ☐ Coláiste ☐ Bean an Tí (please note that accommodation requests are subject to availability and can not be guaranteed)
CARA / Friend - Do you have a friend that you would like to share accommodation with? _________________________________________________________
(please note a maximum of one friend can be listed and both forms must correspond and arrive together - see note 4)
I have read and accept the rules and terms of application and the disclaimer overleaf.
My child understands that he / she must make every effort to speak Irish during the course and that failure to do so will lead to dismissal from the course.
SIGNATURE OF STUDENT __________________________________________________________
SIGNATURE OF PARENT / GUARDIAN __________________________________________________
DÁTA: ____________________
DÁTA: ____________________
DEPOSIT ENCLOSED (50%): Amount ________________ ☐ Cheque ☐ Bank Draft ☐ Postal Order ☐ Laser ☐ Visa ☐ Mastercard
Name on Card __________________________________________ Card No
Signature ______________________________________________ Exp Date _____________________ CCV No ________________
NB - Online booking is advised as our prefered method for Laser Visa and Mastercard payments for securtity reasons.
All Visa / MC transactions attract a 2.5% handling fee imposed by the banking institutions. PLEASE MAKE CHEQUES PAYABLE TO EACHTRAÍ UISCE TEO.

TERMS OF APPLICATION
1. General terms
Price inclusive of: Accommodation, food, ranganna Gaeilge and all activities are included in the course cost. Please note water activities (Sailing, Windsurfing, Surfing and Kayaking) are
weather permitting. Price not inclusive of: travel to / from Coláiste UISCE, private laundry requirements and tours during the course.
Deposit - A deposit of 50% must accompany application forms. Discount Vouchers will be credited off the balance due.
Easy Pay - A 4-part Easy Pay option is available on request.
Confirmation - A course place is only confirmed on receipt of a course reference number (uimhir thagartha).
Balance
Discounts
- The balance due must be paid 2 months before the course start date.
- Only discount vouchers valid for the current year will be accepted. Only one voucher is accepted per application form.
All vouchers must be submitted with the application form and deposit.
There is a €30 family discount for immediate members of a family attending Coláiste UISCE. When the family discount is availed of no other discount voucher is accepted.
2. CANCELLATION POLICY
1. The balance of the course fee is payable 2 months prior to the course start date.
UISCE reserves the right to treat a booking as cancelled due to non-payment of the balance by the due date.
2. All cancellations must be in writing.
3. A full refund is issued up to 2 months prior to the course start date, minus an administration fee.
4. A 50% refund is issued up to 1 month prior to the course start date, minus an administration fee.
5. In the event of cancellation less than 1 month prior to the course start date the FULL FEE is forfeited.
6. Course bookings can be transferred up to 1 month prior to the course start date subject to availability.
7. An administration charge of €30 will be charged for all cancellations processed.
8. A €5 charge will apply to all bounced cheques.
3. Poist FHreagracha
A limited number of places are available to students 17yrs+ who wish to accept a position of responsibility during
the course. See separate brochure and application form for details of positions of responsibility.
4. ACCOMMODATION
Accommodation is provided at specially selected local houses or in the purpose built en-suite accommodation at the
Coláiste. If you have a preference for either, please specify on the application form. Please note all requests are
subject to availability. Coláiste UISCE encourages friends to attend together however in the interest of ensuring an
Irish atmosphere a maximum of 2 friends may be accommodated in the same room. Both forms MUST correspond
and arrive together when naming friends. Groups of more than 2 will be separated into smaller groups.
RIALACHA / Rules of the Coláiste
Coláiste UISCE Policy Statement regarding Children &
Sport (the code of Ethics and Good Practice for Children’s
Sport – Irish Sports Council) encourages a positive Irish
learning atmosphere in Coláiste UISCE. We respect each
other’s rights and place emphasis on creating a safe
learning environment. We therefore expect all students to
conduct themselves in a positive, well mannered and cooperative
manner. In order to achieve the above, students
are expected to adhere to the rules of the Coláiste for the
duration of the course.
Riail na Gaeilge / The Irish Rule
• Caithfidh gach duine iarracht a dhéanamh Gaeilge a
labhairt i gconaí.
• Students must make a determined effort to speak Irish
at all times. Repetitive non compliance of this rule will
result in dismissal from Coláiste UISCE.
5. SLÁINTE / HEALTH / SPECIAL REQUIREMENTS
Students suffering from a recent injury, asthma, food allergies or any medical condition must specify so in the “Health” section overleaf.
If an injury or condition develops after completion of the form the Coláiste UISCE staff must be notified by phone and in writing. To help us best accommodate your child’s needs it is vital
that you inform us of any concerns, issues or needs your child may have prior to attending UISCE, e.g. ADHD, Sleep Walking, Weak Bladder, Aspergers etc
6. PHOTOGRAPHY POLICY
Students are not permitted to take photographs or video footage in the changing rooms or bedroom areas. Students must be in suitable dress and agree to their photograph being taken
in order to reduce the risk of improper use. Photographs and video footage taken while in UISCE may not be used on Facebook, Bebo, Youtube or any similar sites without prior permission
of all parties. UISCE takes every precaution to ensure each student’s privacy is respected and asks parents to be aware of their child’s activity on these sites.
In accordance with the Code of Ethics and Good Practice in children’s sport Coláiste UISCE wishes to advise parents that photos may be taken of your child during activities.
The photos may be then used in the marketing and promotion of Coláiste UISCE in compliance with the code of ethics guidelines.
SÉANADH / DISCLAIMER
I accept that the activities taught in Coláiste UISCE are classified as Adventure Sports and therefore by their nature have an element of risk attached. I declare that my child is
in good health and not suffering from any illness, injury, or disability which will interfere with the activities at Coláiste UISCE or which has not been brought to the attention of
the management of Coláiste UISCE. I therefore accept that despite all precautions that may be taken through safety procedures, equipment, student / instructor ratios, etc. that
there is an element of risk associated with adventure sports and that the staff and management of Coláiste UISCE cannot be held liable for any accident which may occur during
these activities which are not due to their negligence.
PLEASE FORWARD TO: Coláiste UISCE, Cuan Eilí, O.P. Clochar, Béal an Átha, Co. Mhaigh Eo OR CONTACT: TEL: 097-82111 EMAIL: eolas@uisce.ie WEB: www.uisce.ie
RCPT
AMOUNT
DON OIFIG AMHÁIN / FOR OFFICE USE ONLY
Course Fee
Family Disc
Discount / Scholarship
Credit Card Fee 2.5%
Item Sent
Receipt
Joining Instructions
Date & Initials Date & Initials Date & Initials
Amount Due DÁTA PAYMENT METHOD CHQ NO CHQ AINM SLIP DB
Payment 1
Payment 2
Payment 3
Payment 4
Insurance
Travel
Total Paid