Formulaire de consentement parental

Formulaire de consentement parental

Students under 18

Child's Name *

Prénom

2ème prénom

Nom

Nationality *

Date de naissance *

Date of arrival *

Date of departure *

Parent or Legal Guardian Name *

Prénom

2ème prénom

Nom

Email *

E-mail

Confirmez l’e-mail

Emergency Phone Number 1 *

Emergency Phone Number 2 *

Checkbox 1 *

Oui

ISI Dublin will only use the above personal information to contact you in emergency situations. Please confirm your consent to this and your consent to our other policies regarding personal data, as outlined in the document General Data Protection Regulation for Data Processor below and on our website www.studyinireland.ie/en/site-information/cookie-and-privacy-policy, by clicking 'YES'.

Checkbox 2 *

Oui

Do you consent to ISI Dublin's Authorisation and Consent Document for students aged under 18, as outlined below?

Checkbox 3 *

Oui

Do you confirm that your child is fully aware of ISI Dublin's Discipline and Behaviour Agreement and that he/she agrees to abide by all the rules contained therein?

Special condition *

Please indicate above any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child: (please write "N/A" if this does not apply to your child or if this information has already been supplied via a third party agency)

Signature *

Date *

Agree *

Oui

I agree to the , and to the

Discipline & Behaviour Agreement

All students are subject to Irish law for the duration of the programme. Students are also subject to the discipline policies and rules of their specific junior and their host family.

The following actions are in all circumstances prohibited:

1. Consuming any alcoholic beverage.

2. Taking any type of illegal drug or un-prescribed medicine; associating or having contact with any person involved in or associated with un-prescribed or illegal drugs. (You must inform ISI Dublin if you are taking any prescription medication).

3. Smoking in or around school premises or on school activities or at the host family.

4. Driving a car or motorbike.

5. Staying away from the host family/residential school overnight without permission from:

ISI Dublin and
the host family/school and
your parents/guardian (in writing)

6. Being absent from school without permission of a parent/guardian/host family.

7. Leaving the school premises or activity without permission from the school.

8. Travelling outside your residential area without the permission of ISI Dublin and your parents/guardian.

9. Borrowing money from classmates or lending money to classmates.

10. Inviting friends to host family/residential accommodation without prior permission from the host family and ISI Dublin.

11. Bullying of fellow school pupils or other students on the programme.

12. Using mobile phones during class time, unless invited to by the teacher.

13. Employment of any kind, paid or unpaid, unless agreed by ISI Dublin.

14. Getting a tattoo or body-piercing.

15. Cooking in your host family’s home without permission to do so.

16. Engaging in a sexual relationship and/or engaging in online communication of a sexual nature, i.e. sending/posting sexually explicit texts, messages, photos or videos.

17. Any acts which might cause injury to someone or damage to someone’s property at school, at the host family, during activities and in free time.

18. Breaking curfew (as outlined below).

19. Disturbing classmates during class or behaving inappropriately or unacceptably during class.

20. Being absent from school. All absences must be justified (for example certified sickness). Students on ISI Dublin’s High School Programme should note that if they are absent for 20 days or more they risk being expelled from both the school and the High School Programme programme.

Other ISI rules and guidelines.

1. Respect must be shown at all times to your teachers, your host family, all staff members of ISI Dublin and other students.

2. You are expected to do all homework set by your teachers.

3. You must obey the following curfews, except where special evening events have been organized by ISI Dublin as part of the programme and/or prior permission has been granted.

You must be home by dinner time each day (you can confirm this time with your host family).
You are allowed to socialise in the LOCAL area only until 9pm from Sunday – Thursday.
You are allowed to socialise in the LOCAL area only until 10pm from Friday and Saturday.

4. In all cases the host family must be informed of:

where you are going
the time you expect to return
who will be with you

Disciplinary Action

Breaches of the rules and norms of ISI Dublin, the host family, and/or the school, can result in:

Stage 1: Formal Verbal Warning (witnessed)

Stage 2: First Written Warning (signed and witness)

Stage 3: Final Written Warning

Stage 4: Expulsion

In serious cases of disciplinary action, the verbal or first or final written warning may be foregone. In the final case, the student will be expelled from the programme and sent home immediately.

Alternatively, a punishment more appropriate to the breach of discipline may be imposed (e.g. writing a letter of apology or an earlier curfew).

Breaking the law in Ireland (such as stealing from shops, damage to property, use of alcohol or illegal drugs) will result in immediate expulsion from the programme. There will be no refund of fees if you are expelled from the programme.

To learn even more about ISI Dublin, we invite you to visit our main website.

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