Scoil Naisiúnta An Chroí Ró-Naofa

ENROLMENT APPLICATION FORM 2016/2017 (Junior Infants)

Name of Child: / Date of Birth:
PPSN:
Address: / Religion:
This form must be accompanied by a) a Birth Certificate / b) a Baptismal Certificate (if child was baptised outside Parish)
Father’s Name: / Mother’s Name:
Mother’s Maiden Name (if different from above):
Address: / Address:
Home Phone No.: / Home Phone No.:
Work Phone No.: / Work Phone No.:
Mobile:
E-Mail Address: / Mobile:
E-Mail Address:
Is Father past pupil of this school? YES NO / Is Mother past pupil of this school? YES NO

Does your child have a sibling(s) already in the school?: YES No
Name ______
Name: ______
Name: ______
Name: ______ / Class:______
Class:______
Class:______
Class:______
Does your child have a sibling(s) who have not yet started school?: YES No
Name ______
Name: ______
Name: ______ / D.O.B:______
D.O.B:______
D.O.B:______
Person(s) to contact in any emergency when neither parent is available:
Name : ______Contact Number: ______
Name : ______Contact Number: ______
Name of Family Doctor:
Phone Number: / Does your child have any allergies or medical conditions that the school should know about?: If yes please give details…

Does your child have any specific learning difficulty? YES NO
If yes please give details….
Please furnish any assessment records you may have concerning this child
eg. Educational Psychologist, Speech & Language, Occupational Therapy
Do you give permission for your child to attend Learning Support if the need arises? Yes No
Any other relevant information....

Does any legal order under family law exist that the school should know about? YES NO
If yes please give relevant details ......
Do you give permission –

  1. To take your child straight to the hospital in the case of serious illness or accident ? YES NO

  1. To include your child’s name on the class list sent to the HSE (dental/eye clinic) ? YES NO
  1. To attend activities outsideof schooli.e. Swimming, Athletics, Cumman Na mBunscol and any other events that may take place and travel on transport provided. YES □ NO □
  2. To have images of your child 's work on our website, in our school or in local newspapers. YES □ NO □
  1. To Rath NS to take and use photographs, and /or digital images of my child for use in printed publications or materials, electronic publications, School website and classroom displays for the duration of their time in school. YES □ NO □

Data Protection Acts 1998 –2003 (parent/ guardians, please sign )
I/We hereby consent to the retention in the school of the enclosed data either manually or electronically.
Signed: ______/ Signed: ______
Date: / Date:

PLEASE NOTE –

  • The details on this form remain in place while your child is in this school.
  • Please inform us in writing of any change of address, telephone contact numbers etc.
  • This information covers your child from Infants to 6th Class inclusive. If circumstances change please inform the school immediately.