Select which class this enrolment form is for:
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Mainstream Junior Infants
Mainstream other class (specify below)
Early Years (Preschool) ASD class
Primary ASD class
If you have selected "Mainstream other class" above, please specify which class:
Name of Child
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First Name
Last Name
Date of Birth (dd/mm/yyyy)
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Nationality
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Religion
No Consent
Will your child be making their Holy Communion
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Yes
No
Name and address of pre-school or previous school attended
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Phone no. of previous school
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(###)
###
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I give permission to Méabh Hennessy (principal) to discuss the needs of my son, with the manager of the pre-school/school listed above
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Yes
No
Name and phone no. of Family Doctor
*
In the event of an emergency, should we fail to contact you, do you give permission to the School to bring your child to doctor/hospital
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Yes
No
Name and class of siblings already in the school
Mother/ Guardian 1 Name
*
First Name
Last Name
Father/ Guardian 2 Name
First Name
Last Name
Mother/ Guardian 1 Phone Number
*
(###)
###
####
Father/ Guardian 2 Phone Number
(###)
###
####
Mother/ Guardian 1 email
*
Father/ Guardian 2 email
Mother/ Guardian 2 Work Number
(###)
###
####
Father/ Guardian 2 Work Number
(###)
###
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Home Phone No.
(###)
###
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Mother/ Guardian 1 Nationality
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Father/ Guardian 2 Nationality
*
Language(s) spoken at home
*
Date of arrival in Ireland (dd/mm/yyyy)
Is child living with both parents?
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Yes
No
With whom does the child normally reside
First Name
Last Name
Home address (please include eircode)
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Alternative Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name
*
First Name
Last Name
Phone No.
*
(###)
###
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Name
*
First Name
Last Name
Phone No.
*
(###)
###
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Do you give permission for your child to go on school trips within walking distance of the school under teacher supervision during the school day e.g trips to the local town park, local historical buildings etc.
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Yes
No
Sometimes journalists visit our school to take pictures of the children e.g awards/prizes, sporting events, first day at school etc. Do you give permission for your child to be photographed for school projects, local newspapers, and school related activities?
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Yes
No
Do you give permission for your child’s photo/video/work to be used on the school website, school facebook page and for school promotion?
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Yes
No
Sometimes the school is requested to pass on names of children and their addresses to the Health Board for immunisation purposes, to secondary schools when children are transferring to second level, to sporting bodies when children are taking part in games outside the school. Do you allow the school to pass on this information to these three bodies?
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Yes
No
The school teaches Relationships and Sexuality Education (RSE) using the guidelines provided by the Department of Education and Science. If you have any concerns with regard to RSE please tick this box so that an appointment will be made with the principal to discuss your concerns.
Date of Signature (dd/mm/yy)
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Teacher/ Class Name
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Current class at school
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Pupil Name
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First Name
Last Name
PPSN of Pupil
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Mother's Birth Surname
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Pupil's Date of Birth (ddmmyy)
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Pupil's Gender
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Male
Female
Birth Cert Forename & Surname (if different from name above)
Pupil Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Pupil Nationality
*
What is your child's religion?
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Roman Catholic
No consent
No religion
Muslim (Islamic)
Church of Ireland (Anglican)
Orthodox (Greek, Coptic, Russian)
Christian Religion (not further defined)
Apostolic or Pentecostal
Other Religions
Hindu
Presbyterian
Atheist
Baptist
Buddhist
Protestant
Jehovah's Witness
Medhodist/ Wesleyan
Lutheran
Agnostic
Evangelical
Jewish
Is one of the pupil’s mother tongues (i.e. language spoken at home) Irish or English?
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Yes
No
No Consent
Date of Signature (dd/mm/yy)
*