Surname / First Name(s)
Middle Name / Title / Date of Birth (dd/mm/yyyy)
Nationality
(as in Passport) / Print Name
(as per Passport)
Relationship Status
Date of Marriage
(if applicable)
Permanent Address
Email Address / Skype Address
Telephone / Home / Work / Mobile
(with international dialling code)
Dietary requirements
(if applicable)
Registration Information (Female)
Surname / First Name(s)
Middle Name / Title / Date of Birth (dd/mm/yyyy)
Nationality
(as in Passport) / Print Name
(as per Passport)
Relationship Status
Date of Marriage
(if applicable)
Permanent Address
Email Address / Skype Address
Telephone / Home / Work / Mobile
(with international dialling code)
Dietary requirements
(if applicable)
CHILDREN ATTENDING
Participating in the Cana Week programme means that your children will be cared for lovingly but separately for an extended period in the morning and again in the afternoon each day. If separation is an issue for you or your child, you might consider waiting until he/she is older in order to get full benefit from the week. Unfortunately we don’t have the capacity to take care of children under 3 years old. If you have a child under this age we suggest you bring an au-pair or family member to take care of your child throughout the week. The au-pair of family member will be the sole responsible person for your child at all times, independent of older children.
Child protection policy: In accordance with National Guidelines for Child Protection, Cana Ireland have a Child Protection Policy in place which supports volunteers to work with children and vulnerable adults in a way that is safe, positive and which upholds the rights and dignities of all concerned. Throughout the Cana week, Child protection policies will be fully adhered to.
Registration Information(Child 1)Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
Registration Information (Child 2)
Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
Registration Information (Child 3)
Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
Registration Information (Child 4)
Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
Registration Information (Child 5)
Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
Registration Information (Child 6)
Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
Registration Information (Child 7)
Surname / First Name(s)
Middle Name / Sex of child / Date of Birth (dd/mm/yyyy)
Food allergy or dietary requirements
(if applicable)
General information
1 / What do you know about the work of Cana Ireland?
2 / Why are you applying to attend the Cana Week and what do you hope to gain from the programme?
Where did you hear about Cana Ireland?
If from a friend please let us know the name of the friend
3 / Are you affiliated with any Christian denomination/group? Give details.
Any other questions?
Signature / Date
Please returnthis form electronically to or by post to Eugene & Maruska Smith, Cana Ireland National Coordinators, 1 Woodstown Drive, Knocklyon, Dublin 16, Ireland.
The Cana programme is a non profit undertaking and costs are shared by all, including the volunteers. The suggested contribution is €700 per couple and €800 per family for the week, payable at the end of the week. The price includes food, accommodation and programme materials for couples and children’s programme. No one is turned away from Cana due to financial restrictions and if there is any problem with this, please discuss with Eugene. Your confidentiality will be respected.
If you are interested in securing a place on the retreat, please forward a deposit of €100
Please tick which ever applies:
I enclose a cheque/bank draft/postal order made payable to Cana Ireland for €100
I will post a cheque/bank draft/postal order made payable to Cana Ireland for €100
I will make a bank transfer payment for €100to Cana Ireland (bank details below)
BANK DETAILS
Account Name: Cana Ireland
Type of Account: Current Account
Name of Bank: Permanent TSB
Bank Address: 2 St. Stephens Green, Dublin 2, Ireland
Account Number: 22329402
Bank Sort Code: 990659
Bank ID (BIC) IPBSIE2D
IBAN: IE44 IPBS 9906 5922 3294 02
Information pack
Closer to the Cana Week we will send you an information pack which contains relevant information about the programme itself, meanwhile if you have an questions feel free to contact us:
Child protection policy
In accordance with National Guidelines for Child Protection, Cana Ireland have a Child Protection Policy in place which supports volunteers to work with children and vulnerable adults in a way that is safe, positive and which upholds the rights and dignities of all concerned. Throughout the Cana week, Child protection policies will be fully adhered to.
Eugene & Maruska Smith,
Cana Ireland National Coordinators,
1 Woodstown Drive,
Knocklyon,
Dublin 16,
Ireland.
Mobile: 0857330191
Email: info@canaireland@org
Website:
Follow Cana Ireland on