KilnadeemaNationalSchool

Scoil Náisiúnta Cillíní Díoma

Loughrea, Co. Galway.

Email: Phone: 091 842532

APPLICATION FORM

PUPILS DETAILS

Name of pupilGender Date of birth

Nationality of childNationality of parents

PPS No.:Language spoken at home:

Address

Telephone no.Religion

Former school / preschoolClass

Please note any medical problems/allergies your child may have. Please inform us of any medical history that may be of relevance to your child’s wellbeing in school.

PARENTS DETAILS

Father’s name Mother’s name

Address Address

(if different from pupil’s)(if different from pupil’s)

Occupation Occupation

Phone Work Phone Work

When a child spends time in two homes we assume that when we wish to communicate with parents regarding their child, the parent who is contacted (ie: the parent with whom the child principally resides) will inform the other parent of meetings, arrangements etc.

The school should be made aware of any court order which affects the child’s welfare and also the name of any person into who’s custody the child should not be given.

SIBLINGS

If other members of family already attend Kilnadeema N.S. please state:

Name Class

I have attached my child’s Birth CertificateYesNo

I have attached my child’s Baptismal Certificate YesNo

CONTACT NUMBERS

While we make every effort to ensure the safety of your child, we may need to contact you in the event of an accident or an unexpected closing.

Please fill in the following:

Pupil’s Name:

Contact number for texts:

Alternative* Contact Numbers (not your own number):

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Contact 1.

NAME:

Relationship to Child:

ADDRESS:

PHONE NUMBER:

Contact 2.

NAME:

Relationship to Child:

ADDRESS:

PHONE NUMBER:

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*This person should be within 10 to 15 minutes of the school, have their own form of transport and should be known personally to your child.

Should any of these numbers change while your child is attending this school please inform us immediately.

In Case of Emergency

In the event of an emergency, should we fail to contact you, do you give permission to the School

-to bring your child to the doctor?

YesNo

-to take your child straight to the hospital via ambulance in the case of serious illness or accident.

YesNo

Signed: ______Date: ______

Please make the above arrangements clear to your child.

APPENDIX TO ENROLMENT POLICY

Please read our Appendix carefully and sign to show your consent and co-operation.

I - Instruction in the Catholic Faith

Kilnadeema N.S. is a Catholic school whose school plan is underpinned by its Catholic ethos. Our aim is to provide a safe, happy learning environment where children’s emotional, psychological, physical and moral development is catered for in addition to their academic progress. The school promotes and expects from its pupils, a tolerance of different religious beliefs, and of those with no religious beliefs.

(1)I wish my child to be instructed in the Catholic Faith:

We/I understand that Kilnadeema N.S. is a Catholic School and wish our/my child to be taught the Catholic faith.

YesNo

(2)Respect for the beliefs of other:

  1. We/I understand that there is no compulsion on our/my child to take part in the Religious Education classes in school
  2. We/I understand that, given the lack of supervision resources, it will not be possible for our/my child to be outside the classroom during these lessons.
  3. While we/I do not wish our/my child to be taught the Catholic faith, we/I respect the rights of other children to do so and we/I will ensure that our/my children do or say nothing that would undermine or compromise this basic right to religious expression.

II - CODE OF BEHAVIOUR

We / I have received, read and understand the Code of Behaviour. We / I agree to abide by this Code and will work in co-operation with the staff to ensure our child understands and keeps the Code.

III - PAYMENT CONTRACT

We / I understand that from time to time there will be certain costs relating to my child’s education in Kilnadeema N.S.. These costs will be mainly in the area of books, book rental, educational equipment and materials.

We / I agree to pay these costs. In the event that we are not in the position to pay it we / I will approach the principal to arrange a payment / plan or alternative plan.

IV - SCHOOL UNIFORM

We / I understand that full school uniform is mandatory in Kilnadeema N.S. and will ensure that my child will wear the correct and full school uniform every day.

V – MULTI MEDIA

Kilnadeema N.S. has a school website and Facebook page which will display children’s work and occasionally images of the children named or unnamed. In the event of school achievements / celebrations photos may be submitted to the local / national newspaper either by the school or the organising body of the event.

VI – TRANSFER OF PERSONAL DATA

Each year, the Health Service Executive request that the personal data of each pupil in various classes be forwarded to them. The data required is: pupil’s name, address, D.O.B., contact phone number and PPS number if available. This information will enable the School Health Team to plan in advance, prepare records and avoid unnecessary repeat visits. Out of respect for family privacy and also in order to comply with the Data Protection Act, it is necessary to receive your consent or otherwise regarding this matter.

VII – SPHE

The Department of Education and Skills published procedures for all schools in relation to child protection and welfare. These guidelines promote the safety and welfare of all children and are to be welcomed. The Board of Management of Kilnadeema NS has adopted these guidelines as school policy. Consequently, if school staff suspect or are alerted to possible child abuse, they are obliged to refer this matter to the Health Service Executive (HSE). The HSE will then assess the situation and provide support for the child concerned. Children First, the National Guidelines for the Protection of Children may be assessed on the website of the Department of Children and Youth Affairs.( and the Department of Education and Skills Child Protection Procedures can be read on the Department’s website ( Parents/Guardians are also welcome to look through the guidelines here at the school.

Kilnadeema N.S. implements the Stay Safe Programme and Relationships & Sexuality Education (RSE) programme in order to teach children about personal safety in various different contexts. While both programmes are endorsed by the Department of Education, Parents have a right to withdraw their child from these lessons.

Please retain the Appendix (Page 3 & 4) for your own reference and return this sheet to the school.

Please tick:

I (1)Instruction in Catholic Faith YesNo

I (2) Will respect the religious beliefs of all in the school communityYesNo

II Will uphold the Code of Behaviour YesNo

III Agree to payment contract YesNo

IV Will ensure my child wears full school uniform every dayYesNo

VAllow the use of my child’s image on the school website / social media.YesNo

Allow the use of my child’s image for the purposes of

promoting the school and personal achievements in newspapers / websites. YesNo

Allow the use of my child’s image for the purposes of

reporting on / promoting an event in which the school is participating in.YesNo

VITransfer of personal data to HSEYesNo

VIII wish my child to partake in Stay Safe ProgrammeYesNo

I wish my child to partake in RSE Programme YesNo

Child’s Name: Signature of Parents/Guardians:

Pupil Information required for

Department of Education and Skills

Primary Online Database

The Department of Education and Skills has developed an electronic database of primary school pupils called the Primary Online Database (POD) which will involve schools maintaining and returning data on pupils to the Department at individual pupil level on a live system. The database will allow the Department to evaluate progress and outcomes of pupils at primary level, to validate school enrolment returns for grant payment and teacher allocation purposes, to follow up on pupils who do not make the transfer from primary to post primary level and for statistical reporting.

The database will hold data on all primary school pupils including their PPSN, First Name, Surname, Name as per Birth Certificate, Mother's Maiden Name, Address, Date of Birth, Gender, Nationality, whether one of the pupil's mother tongues is English or Irish, whether the pupil is in receipt of an Exemption from Irish and if so the reason for same, whether the pupil is in receipt of Learning Support and if so the type of learning support, whether the pupil is in a Mainstream or Special Class. The database will record the class grouping and standard the pupil is enrolled in. The database will also contain, on an optional basis, information on the pupil's religion and on their ethnic or cultural background.

In order to assist with the gathering of data please complete page one and two of this form in CAPITAL LETTERS and return to the school with your enrolment form. This form will be retained by the primary school.

Pupil Forename: Pupil Surname:

Birth Cert Forename (if different from name above)Birth Cert Surname (if different from name above) ______

Pupil AddressPPSN of Pupil Mother’s Maiden Name County

Nationality Gender : Male Female

'Is one of the pupil’s mother tongues (i.e. language spoken at home) Irish or English?

Yes No

The Department has consulted with the Data Protection Commissioner in relation to the collection of individual pupil information for the Primary Online Database. Both religion and ethnic and cultural background are considered sensitive personal data categories under Data Protection legislation. Therefore, it is necessary for each pupil’s parent/guardian to identify their child’s religion and ethnic background, and to consent for this information to be transferred to the Department of Education and Skills. All other information held on POD was deemed by the Data Protection Commissioner as non-sensitive personal data.

To which ethnic or cultural background group does your child belong? (please CIRCLE one)

(Categories are taken from the Census of Population)

White IrishIrish TravellerRoma

Any other White Background Black African Any other Black Background

Chinese Any other AsianOther (inc. mixed background)

background

No consent

What is your child’s religion? (please CIRCLE one)

Roman CatholicChurch of IrelandPresbyterian

(incl. Protestant)

Methodist, WesleyanJewishMuslim(Islamic)

Orthodox Apostolic or Pentecostal Hindu

(Greek, Coptic, Russian)

Buddhist Jehovah's WitnessLutheran

AtheistBaptist Agnostic

Other Religions No Religion No Consent

I consent for this information to be stored on the Primary Online Database (POD) and transferred to the Department of Education and Skills and any other primary schools my child may transfer to during the course of their time in primary school.

Signed: ______Date: ______

Parent/Guardian

Please complete this form and return to your primary school. For further information on POD please go to the Department of Education and Skills’ website

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