Scoil Bhríde, Mercy Secondary School
First Year Students, Sept. 2017
Personal Details
Surname:………………………… First Name(s) ………………………………
(As on Birth Certificate)
Address: ………………………………………………………………….
……………………………… Telephone: …………………………..
(Landline)
Date of Birth: ……………………………… Birth Certificate: Yes: No:
(Please bring your Birth Certificate - long edition)
Country of Birth: ………………………………......
Medical Card: Yes / No: Card No: ………………………………. Exp. Date: ………
PPS (Personal Public Service Number): ………………………………......
Father/Guardian: Name:………………………… Mobile Number: …………………
Mother/Guardian: Name: ……………………….. Mobile Number: ………………….
Mother’s Maiden Name:…………………………………………………………
Please advise school administration of any different mailing arrangements.
E-mail: …………………………………………………………………………………
Primary School Attended: ………………………………
Name of siblings who have attended or attending Scoil Bhríde
……………………………………………………PTO
Do you consent to Scoil Bhríde contacting your daughter’s primary school to collect her Standardized Test results?
Yes/NO (circle yes if you are happy to allow, circle no if not)
Does your daughter have a certified exemption from Irish? ……………………
Does your daughter require any special provisions arising from a disability?
………………………………………………………………………………………………………………………………………………………………………………………………
Does your Daughter have any medical conditions that the school should know about?
………………………………………………………………………………………………………………………………………………………………………………………………
Are you happy to receive booklists, academic calendars and other information by email over the coming months?
Yes/NO (circle yes if you are happy to allow, no if not) please check you have given the correct email address above.
Do you give permission for your daughter to be filmed, photographed and named for school purposes to be used for articles being sent to newspapers, the school’s Facebook page, website and other school related publications, Yes/NO …………………………………….
Extra interests that your daughter has e.g. sports she plays, musical interests, art, dancing, drama.
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Are you happy to comply in full with the School’s Admission and Participation Policy and the Schools Code of Behaviour and all agreed school policies available on the schools website
......
Signature: …………………………………………………………..
Closing Date for applications Friday November25th2016