Youth Climate Advocate Programme Application Form
Participant Details
First Name
Last Name
Email
Date
of Birth (DD/MM/YYYY)
Gender
Please select...
Male
Female
Non-Binary
Trans-Masc
Trans-Fem
Other
Mobile Number
County
Please select...
Co Antrim
Co Armagh
Co Carlow
Co Cavan
Co Clare
Co Cork
Co Derry
Co Donegal
Co Down
Co Dublin
Co Fermanagh
Co Galway
Co Kerry
Co Kildare
Co Kilkenny
Co Laois
Co Leitrim
Co Limerick
Co Longford
Co Louth
Co Mayo
Co Meath
Co Monaghan
Co Offaly
Co Roscommon
Co Sligo
Co Tipperary
Co Tyrone
Co Waterford
Co Westmeath
Co Wexford
Co Wicklow
School Year if applicable
Please select...
3rd Class
4th Class
5th Class
6th Class
1st Year
2nd Year
3rd Year
4th Year
5th Year
6th Year
Participation Details
Why would you like to get involved in the Youth Climate Advocate Programme?
When are you available to join our sessions starting in September and ending in the first week of December? Please note the session duration may be between 1.5-2 hours long. ( Please select as many options as you like)
Monday 18:00-20:00 pm
Monday 18.30-20:30 pm
Tuesday 18:00-20:00 pm
Tuesday 18.30-20:30 pm
Wednesday 18:00-20:00 pm
Wednesday 18:30-20:30 pm
Thursday 18:00-20:00 pm
Thursday 18:30-20:30 pm
Friday 18:00-20:00 pm
Friday 18:30-20:30 pm
Saturday morning
Saturday afternoon
Sunday morning
Sunday afternoon
How would you like to join the Youth Climate Advocate Programme?
Please select...
In Person (Dublin Only)
Online
Hybrid
How did you hear about Youth Climate Advocate Programme?
Please select...
Radio
Referral
Word of Mouth
Television
Social Media
Press/Newspaper
Internet Search
Eco-Unesco Event
Parent/Guardian Details
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
Parent/Guardian Mobile
Emergency Contact Details
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
To be completed by the Parent/Guardian
I, parent/guardian of the above named participant, hereby consent that they are given full permission to participate in ECO-UNESCO’s Youth Climate Advocate Programme and in any activities associated with the programme, be they internal or external.
Yes, I give full permission to participate
Medical Assistance
:
By signing this form, you are ECO-UNESCO to undertake appropriate first aid assistance in case of injury, accident or medical emergency.
I consent
Have you any special requirements/disability/allergy/addiction/issue that we should know about? If yes, please outline the supports you require below.
Photographs and Videos
:
ECO-UNESCO may use images and/or video from our activities for publications and promotional purposes.
I consent
I do not consent
Data Protection and Privacy
: We will not share the above details with any third party. These details will be maintained within our participant files and we may contact you in the future about other ECOUNESCO services. All participants are signed up to our monthly e-bulletin newsletter. You may unsubscribe at any time
Yes, I consent to the
data protection, privacy terms & conditions
Contact Information