Scoil Chaitríona, Cappamore, Co. Limerick.
Email:eb:
Tel: 061-381774 Roll No: 20233L
APPLICATION FOR ENROLMENT 2018/2019
CHILD’S DETAILS (PLEASE PRINT)
Child’s Name: ______
Date of Birth (Please attach Birth Cert): ______
Nationality: ______
Child’s P.P.S. number: ______Religion:______Place of Baptism:______
(Please attach Baptismal Cert if baptised outside the Parish)
Previous school or Playschool attended: ______Phone No.:______
Names and ages of brothers/sisters: ______
Would you like to receive news from the school by email: Yes No
PARENTS/GUARDIANS (PLEASE PRINT)
Mother’s /Guardian’s Name:______Home Tel. No.______
Address:______Mobile No.______
Nationality:______Occupation: ______Work No. ______
Email Address: ______
Father’s /Guardian’s Name:______Home Tel. No.______
Address:______Mobile No.______
Nationality: ______Occupation:______Work No. ______
Email Address: ______
HEALTH
Child’s Doctor: ______Phone No.: ______
Medical Card No.:______
Has your child ever attended: (a) Speech Therapist (b) Occupational Therapist (c) Psychologist (d) Counselling (e) Other (give details):______Yes No
-If ‘yes’ please give details:______
(If ‘yes’ a copy of reports should be given to the school)
Most Recent Appointment Date: ______
Does your child suffer from asthma? Yes No
-If yes’ please give details:______
Is your child allergic to any medicine/food substance? Yes No
-If yes’ please give details: ______
Does your child have any physical, emotional or other needs, which might affect his/her ability to learn and or to interact with the staff and students? Yes No
-If ‘yes’ please specify:______
Note: allergies, anaphylactic shock, Asperger’s Syndrome, Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, Autism, Cerebral Palsy, Dyspraxia, epilepsy, fainting fits, poor vision, speech defects or impediments etc. would be considered needs which should be notified to the school.
Does any legal order under the family law exist that the school should know about? Yes No
-If ‘Yes’ is there any person into whose custody your child should not be given? ______
(Please also attach details)
PRINT CONTACT DETAILS (PLEASE)
It is essential that we have a phone number of someone we can contact in an emergency, if you are not available.
Name: Phone No. Relationship to child
1. ______
Should this number change please inform us immediately.
In the event of an emergency, should we fail to contact you, do you give permission to bring your child to the doctor on duty/and hospital? Yes No
CONSENTS:
1. Do you give permission for your child to participate in school trips e.g. walks, school tours, etc. Yes No
2. 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? Yes No
3. Do you give permission for your child’s religion and ethnic background to be stored on the Primary Online Database (POD) and transferred to the Department of Education and Skills? Yes No
I certify that the information I have given in this form is correct.
I consent to the administration of all relevant screening tests to the above name pupil.
I further undertake that he/she will comply fully with all School Rules in Scoil Chaitríona Primary School.
Parent's/Guardian's Signature(s)______Date:______
Please return this form to the Principal, with your child's Small Birth Certificate/ and
Baptismal Certificate if your child was baptised outside the Parish. These forms will be returned to you
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