IRISH ASSOCIATION FOR GIFTED CHILDREN.

An Óige Thréithnach

FAMILY MEMBERSHIP FORM

CONFIDENTIAL

NAME OF PARENT(S) or GUARDIAN(S):_________________________________________________DATE_____________

Address: ___________________________________________________________________________

___________________________________________________________________________

Telephone: (Home) ____________________________________(Daytime) __________________________

Email address____________________________________________________________________________

How did you hear of the Association?____________________________________________________________________

 
 

Full Names of children

D.O.B.

Been assessed? (Y/N)

Where do they attend school?

Comments.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I agree/ do not agree to have my name, address and telephone number being included on a membership list circulated to members.

 

Signed __________________________________________

Please return with 20 subscription to

Irish Association for Gifted Children (IAGC)
An Óige Thréitheach (AOT)
Carmichael House
4 North Brunswick Street
Dublin 7
Contact Telephone: (01) 873 5702