Kilmore Road
Artane
Dublin 5
Ph: (01)8477193:
Fax: (01)8477193
APPLICATION FORM FOR ADMISSION TO SENIOR INFANTS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.
APPLICATION FORM FOR ADMISSION TO FIRST CLASS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.
APPLICATION FORM FOR ADMISSION TO SECOND CLASS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.
APPLICATION FORM FOR ADMISSION TO THIRD CLASS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.
APPLICATION FORM FOR ADMISSION TO FOURTH CLASS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.
APPLICATION FORM FOR ADMISSION TO FIFTH CLASS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.
APPLICATION FORM FOR ADMISSION TO SIXTH CLASS
Child’s Full Name: ______P.P.S. No. ______
Address: ______
Date of Birth: ______Religion: ______Nationality: ______
Mother’s Name: ______Mobile No: ______
Home Ph No: ______Work No: ______
Father’s Name: ______Mobile No:______
Home Ph No: ______Work Ph No: ______
Address: ______
(If different from pupils)
Parish: ______
Emergency Name 1:______Ph No: ______
Emergency Name 2:______Ph No: ______
Does your child have any problems in any of the following areas? Please tick:
Asthma: Hearing: Kidney: Sight: Speech: Other:
Comments re health care: ______
Family Doctor’s Name: ______Doctor’s Phone No: ______
Present/Previous Schools/Playschools (give details): ______
Sisters at present attending school: ______
Proposed Date of Entry: ______
I apply for admission of the above named pupil, and I agree to abide by the schools regulations:
SIGNATURE OF PARENT/GUARDIAN: ______
DATE: ______
Please enclose a Birth Certificate and a Baptismal Certificate if applicable with this application.