SCAN Student Participation Form

SCAN Membership Form

PART A - Membership Information. Answer questions 1-8 below. 1. Name and email of parent completing this form. *
2. Parent /guardian contact number(s) *
If you would like recieve parent messages via SMS about in-person and online SCAN meetings, please enter the number here
3. Student full name *
4. Student date of birth *
5. Student/young person contact email *
6. Parent / guardian postal address (a print out of this form will be posted to you) *

7. I/we hereby apply for membership of the Students’ Climate Action Network (SCAN) on behalf of my child. *
8. As parent(s)/Guardian(s) of the young person named in Part A(3), (tick to confirm): * We/I consent to this membership application We/I understand that the personal data on this form will be used by SCAN for the purpose of registering and maintaining my child's membership, and for communications concerning activities of SCAN We/I understand that the personal data will be retained by SCAN for as long as the applicant remains a member We/I understand that I/my child can end their Membership by writing to the SCAN and all their personal data will then be erased, except for a minimum membership record for archival purposes
PART B - Parental permission to attend events in person. As parent/ guardian of the student named in PART A(3) above - Please TICK to indicate permission: I grant permission for my child to take part in the in-person local events (meetings and workshops) of SCAN, at the times and dates and locations advertised on the SCAN website (see website). I grant permission for my child to take part in all-ireland events of SCAN events (meetings and workshops), at the times and dates and locations advertised on the SCAN website (see website). I commit to checking the specific dates, times and locations of SCAN activities which my child plans to attend on the SCAN website. I will note the full address of the event venue that my child is attending, in order to be able to collect them in case of emergency or illness. I understand that for some SCAN meetings or events specific forms confirming additional parental permission will be needed, e.g. once-off events, outdoor activities, residential events, trips.
PART C - Permission to participate in online activities. 1) As the parent/ guardian of the student named in PART A(3) above, I give permission for my child to participate in the following online activities of the network - Please TICK to indicate permission:: Receiving email updates to their email address from SCAN. If you give consent for your child to use receive email updates, their name and email address will be shared with ActionNetwork.org. Parents should read the privacy policy of the Action Network here: https://actionnetwork.org/privacy Viewing and exchanging messages on an online platform called ‘Slack’ after the meeting. Only students aged 13+ whose parents have provided permission to use Slack, and who have attended SCAN meetings are permitted to join the SCAN Slack workspace. Private messages are possible to send, but are not permitted. If you give consent for your child to use Slack, their first name, school name and email address will be shared with Slack. Parents should refer to the Slack privacy policy here - https://slack.com/intl/en-ca/privacy-policy. Attending live online meetings using an online platform called Cisco WebX. Parents/guardians should read the privacy policy of the company Cisco before consenting to this part of the form https://www.cisco.com/c/en/us/about/legal/privacy.html Attending live online meetings using an online platform called Zoom. Parents/guardians should read the privacy policy of the company Zoom before consenting to this part of the form https://zoom.us/privacy Viewing and exchanging messages on an online platform called ‘Loomio’. If you give consent for your child to use Loomio their name, school name and email address will be shared with Loomio. Parents can view the Loomio privacy policy here: https://help.loomio.org/en/legal/privacy/ Viewing and sending emails from a shared Gmail account Co-administrating SCAN content and campaign materials on online platforms the actionnetwork.org and on the SCAN website Co-administrating SCAN accounts on social media platforms
2) Supervision. As the parent/guardian of the young person named in Part A(3) above * I agree that it is my responsibility to fully monitor my child’s online activities. I am aware that the online activities listed in Part C of this form are the only online activities of SCAN. I understand that any online activities not listed here/not advertised on SCAN website/email are not SCAN activities, are not supervised by SCAN volunteer teachers and do not necessarily follow SCAN policies. I confirm that I will read and support ICT acceptable use guidelines when published/updated on the SCAN website.

3) VIDEO during online meetings. We can allow your child to have their camera switched on during meetings if they wish, but please note it is not possible for SCAN to prevent other meeting participants from screenrecording or saving images or video of your child *

PART D – Safety and emergency contact information. 1) The following phone number(s) should be used to contact us in the event that this is necessary. *
Parent emergency contact number 2 *
Additional Emergency contact name and number *
2. As parent/guardian of the young person listed in Part A(3) - Please read and TICK to confirm: * I accept that it is my responsibility to update this emergency contact information immediately should the information above be changed. I will do so by emailing scanteachers@gmail.com I grant permission for SCAN teacher volunteers to authorise emergency medical care by paramedics or hospital staff in the event of a medical emergency I accept that, whilst SCAN teacher volunteers strive do their best to mind all students attending SCAN meetings, workshops and other events, SCAN teacher volunteers are not responsible for the actions of my child or for any unfortunate incident or accident that might befall my child arising from participation in SCAN activities I understand that my child will not be supervised before or after advertised meeting times I confirm that I understand that no travel or school insurance is being provided to my child
PART E – Medical and other issues. 1) Please enter details of any specific access needs, dietary needs, medical needs, allergies or other issues that you wish to inform SCAN teacher volunteers of *
2) As the parent/guardian(s) of the young person listed in Part A(3) - Please read and TICK to confirm: * I understand that it is the responsibility of parents and guardians to inform the SCAN volunteer teachers supervising any event that their child attends, if there are medical or psychological or other issues which could affect their access to the event, their wellbeing, safety or that of other students and/or volunteers I confirm that I have hereby informed SCAN teacher volunteers of any relevant medical or any other needs that could affect the wellbeing or safety of my child or others during SCAN activities I accept that it is my responsibility to update this information about medical and any other relevant issues immediately if circumstances change. I will do so by emailing scanteachers@gmail.com

PART F - Photo and video consent. SCAN students may wish to include photos, videos or names on our website, social media and video channels and other media, and thus we seek your permission to do so. *

FINAL CONFIRMATION. I confirm that I have fully read and understood this form. I will contact scanteachers@gmail.com if I wish amend my responses (Type name and date) *
- If you are not already subscribed, would you like to receive email updates from Students' Climate Action Network? * Yes, opt in to email updates No, do not opt in

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SCAN Membership Form

SCAN Membership Form

The Students’ Climate Action Network is a network of students on the island of Ireland calling for urgent and radical action to prevent climate breakdown and ensure a just and sustainable future.

This is the form that needs to be filled out in order to sign up to participate as a student member in events and activities of the Students' Climate Action Network (SCAN). The purpose of this form is to ensure that the parents/guardians are fully aware of SCAN activities and to reduce the need for parents to fill out lengthy permission forms for each SCAN event. Before filling in this form please visit the social media pages of the Students’ Climate Action Network or contact us for more information at studentsclimateactionnetwork@gmail.com

You may direct any questions about this form, or about the organisation or its policies to the email addresses listed here:

Main organisation contact: studentsclimateactionnetwork@gmail.com (please note this Gmail is managed by a group of students with support from volunteer teachers)

Teacher volunteer contact: scanteachers@gmail.com (managed by volunteer teachers only)

You will need a parent or guardian to complete this form.

The information collected in this form will only be used for purposes of facilitating the student named in the form to participate in SCAN events and activities. The permissions granted by parents/guardians in this form below will be regarded as valid from the date that the form is completed online, until the young person named is 18 years old. After this time the student will be contacted by SCAN to ask whether they would like to continue their membership as a SCAN supporter or SCAN youth leader. If the student does not reply their data will be erased.

There are six parts to this form. The form will take approximately 20 minutes to read and complete – but will save time filling out forms for multiple events and activities.

Part A – Membership information.

Part B - Permission to attend events in person.

Part C - Permission to participate in online activities*

Part D – Safety and emergency contact information*

Part E – Medical and other issues*

Part F - Photo and video consent

* Some additional notes about these sections should be read by parents here before completing the form.

SCAN Membership Form

SCAN Membership Form

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