Name and Surname as it appears on the passport*
Name
Surname
Child's Residential Address*
Full name of the School's Headperson (including title)*
Dr. Miss Mr. Mrs. Ms. Mx. Prof. Rev.
Title
First
Middle
Last
Ex. Dr John Borg or Ms Maria Borg
Medical I/we agree that my daughter is allowed to take paracetamol (Ex. Panadol) in case of headache or period pain* I/we authorise Dr Cristina Micallef MD (MED Reg No: 2570) – leader of ABLAZE Youths – Kalkara to prescribe any medicine she deems fit (including antibiotics) in case my daughter needs so. This is done after consulting with me/us* Consent* I/we agree to inform the leaders of any and all medicine our daughter will be carrying in her luggage
Details of Parents / Custodians Name and Surname of Parent/Custodian 1*
Name
Surname
Address of Parent/Custodian 1*
Same address as child?
Email of Parent/Custodian 1* Can be the same as above
Custody*
Parent/Custodian 2 Name and Surname of Parent/Custodian 2*
First
Last
Address of Parent/Custodian 2*
Same address as child?
In case of emergency Primary Contact Person*
First
Last
Secondary Contact Person*
First
Last
GDPR/Data Consents Consent for information Agree
I/We know that this information is being collected on behalf of the Archdiocese of Malta and that this information is being kept and processed as defined in the General terms and conditions for personal data Protection in parishes (hereinafter referred to as terms and conditions) and in accordance with other applicable ecclesiastical and state laws. This information will be used by the Archdiocese in its various sections related to the Group’s programme. For further information on the retention period, the processing method and rights such as the right of access, the right to data portability, the right to correct, the right to object, the right to withdraw consent given in this form, the right to erasure and the right to lodge a complaint with the supervisory authority, we can access the terms and conditions from the site of the same Archdiocese (www.knisja.mt). To have more information or exercise these rights we can speak to the Parish Priest.
Consent for other entities Agree
I/we know that this information may be given to other entities (not falling under Article 1.4 of the terms and conditions) to be used for purposes related to the programme.
Consent for other scopes Agree
I/we know that this information is kept and used for purposes related to the programme and other pastoral activities related to it. We know that for pastoral and administrative purposes, this information may also be accompanied by correspondence and the attendance of children for programme sessions.
Consent for CCTV Agree
I/we know that the centre at which this programme takes place may be equipped with security camera systems (CCTV) and that these are kept according to what is required by law.
Confirming that the data is correct Agree
I/we declare that the information given in this form is correct and undertake to notify this parish and/or Group (hereinafter referred to as Parish) in WRITING immediately if any change occurs.
Consent for Communication Agree
I/we allow this information to be used to communicate with us through messages (SMS or similar)/email/WhatsApp/Facebook Messenger/or script (in writing) regarding the programme and other related activities.
Audio-visual material Agree
I/we understand and give our consent that the Parish may distribute photographic and/or audio-visual material to third parties featured in the same media.
(without prejudice to our other consents)
Consent for audio-visual Agree
I/we give permission to the Parish to take photos and/or audio-visual footage of our child during the organised activities . These are taken as an internal reference for the parish and can also be used externally on publications and websites including but not limited to social platforms such as Facebook/Instagram/TikTok page or other publications of the parish.
(without prejudice to our other consents)
Data Protection (GDPR) YES
I/we know that for further information or clarifications we can contact the Parish Priest or DPC concerned (
[email protected] ) before signing.
T&C* YES
I/we declare that we were given the opportunity to read the terms and conditions before we signed and that we also know that a copy of them is available on the Archdiocese (knisja.mt) site.
Special Consents Consent for winter sports Choose the type of winter sports you consent that your child participates in
Consent for winter sports Consent
I/we acknowledge and provide consent for my/our daughter’s participation in winter sports activity. I/we grant the group leaders authorisation to sign, on my/our behalf, the indemnification form provided by the skiing resort before the activity begins. I/we understand that these activities may include the inherent risk of fatigue, mental stress and/or injury.
Medical Consents Medical consent Agree
I/we give permission to keep medical information on our child and give it to their caregivers so that they can perform their duties better.
Exhonarate the parish(es)* I/we are exonerating the Parish authorities, including animators and staff of the Centre, from all responsibility
Consent for medical help Agree
I/we consent that in case of need our child will be given first medical assistance and in case of need an ambulance will be requested and/or taken to a health centre or hospital for further treatment, including administering anaesthesia in case of missing emergency numbers within a reasonable time.
Exhonarate if NO* I/we are exonerating the Parish authorities, including animators and staff of the Centre, from all responsibility
Direct or Indirect Liabilities* Consent
I/We fully absolve the group leaders of any and all direct or indirect liabilities and/or direct or indirect responsibilities that may arise in the event that my/our daughter becomes a victim of an accident, regardless of its severity, gravity, or fatality, during the trip.
Damage to third parties* Agree
In the event that my/our daughter causes any harm or damage to third parties, I/we accept full responsibility for any resulting consequences. The group leaders are entirely relieved of any liability in such situations.
Deposit related Consent* I/we agree that I/we will be paying a refundable deposit of EUR 150 for my child’s participation in this Erasmus+ programme in Cluj-Napoca
If the member misbehaves* Agree and consent
I/We acknowledge that in the event of severe misconduct by our daughter, including the use of illegal substances, alcohol, vaping, engaging in sexual activities, being abusive towards another participant, theft, vandalism, or any other illegal actions, she may be required to exit the program. I/We consent to assuming full responsibility for all costs related to repatriating my daughter to Malta. Additionally, I/We accept the obligation to forfeit the deposit and bear the entire expense of the outbound flight from Malta to Romania, as our daughter would not be eligible for coverage under Erasmus+. I/We also agree to be financially accountable for any and all additional expenses that the parish may incur as a penalty from the Erasmus+ Mobility.
In the event of legal consequences arising from the aforementioned misconduct, I/We understand that local law enforcement or relevant authorities may be notified. I/We acknowledge our legal responsibility for any actions or violations committed by our daughter during the program. The parish will not provide legal representation, and all associated expenses for legal proceedings will be incurred by me/us, the parents/guardians. Furthermore, I/We are responsible for reimbursing the program for any damages caused by our daughter, including but not limited to damages to property, individuals, or the reputation of the program. The terms of expulsion from the program may lead to legal actions or penalties, in accordance with local and international laws.
If the member retreats their application* Agree
I/We concur that in the event our daughter opts to discontinue her participation in ABLAZE Youths – Kalkara, we shall forfeit the refundable deposit entirely. The return of the deposit will be contingent upon our daughter submitting her Erasmus+ report.
I/We give our consent that in case the child ceases to be a Member of the Group, any information received will be retained by ABLAZE Youths – Kalkara for sixty months (5 years later) from the date when we formally informed the group that she will be stopping her attendance and/or after ABLAZE Youths – Kalra have completed the requirements set out by Erasmus + Mobility Exchange (5 years later), whichever comes latest.
Other Consents Consent I/we agree that the leaders of ABLAZE Youths – Kalkara issue a travel insurance policy on our behalf (including passing any data collected in this form to the provider).
Final Consents* Agree
I/We are aware that this information is being collected on behalf of the Kalkara Parish Priest (Malta) and that this information is being kept and processed as described in the General terms and conditions for personal data Protection in parishes and in accordance with other applicable ecclesiastical and state laws. For more information on the retention period, the processing method and my rights, such as the right to withdraw the consent given in this form, I can access the General terms and conditions for personal data Protection in parishes on the site of the same Archdiocese (www.knisja.mt). To have more information or to exercise these rights I can speak to the Parish Priest.
I/we declare that I/we have been given the opportunity to read the General terms and conditions for personal data Protection in parishes before I signed.
Parents Signature Name and Surname of Parent/Custodian 1*
Name
Surname
Name and Surname of Parent/Custodian 2*
Name
Surname