Application for Enrolment – St Marys NS Cobh

Step 1 of 2

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Please complete the form and upload your child’s Birth Certificate and any relevant reports.

Child's Name

First

Date of Birth

Day

Month

Year

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of GP

First

Address of GP

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number of GP

PPS Number

Nationality

Is English your child's first language?

Yes

If no please list language(s) spoken at home

Religion

Siblings in the school

Yes

Name of sibling(s)

Child's Previous Primary School (if applicable)

Child’s Pre-School (if applicable):

Does any Legal Order under Family Law exist that the school should know about?

Yes

If yes please provide the school with a copy of the legal order.

General Information on Parent(s)/Guardian(s)

Name of Parent/Guardian 1

Name Mother’s Birth Surname (if different)

Address (if different from child’s)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.

Email Address

Name of Parent/Guardian 2

First

Address (if different from child’s)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.

Email Address

Emergency Contact Details (other than Parents)

Name of contact person 1

First

Relationship to Child

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.

Name of contact person 2

First

Relationship to Child

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.

In the event of an emergency, parents/guardians will be contacted by phone. If immediate contact is not made, the teacher will assume the right to authorise emergency treatment.

Yes (leave untick if no)

Has your child ever been referred to/attended the following services?

Yes

If yes please give details of service along with copies of any reports or referrals received.

Speech and Language

Yes

Occupational Therapy

Yes

Paediatric Services

Yes

Other

Please give details of any health condition e.g. Physical/Emotional/Behavioural /Allergies which may affect your child in school.

Upload birth certificate here and any relevant documents

Max. file size: 2 MB.

Declaration

I/We being the Parent(s)/Guardian(s) of the applicant do hereby confirm that the above information is true and accurate and I/We consent to its use as described. A full copy of the school’s Code of Behaviour and Policies are available for viewing in reception and on the Schools Website. I and my child/children agree to abide by the school’s code of Behaviour.

Signature

Date

Day

Month

Year

Religion, 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.

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

(Categories are taken from the Census of Population)

White Irish

Any other White background

Irish Traveller

Black African

Any other Black background

Chinese

Any other Asian background

Roma

Other(inc. mixed background)

NO CONSENT

What is your child's religion?

Roman Catholic

Church of Ireland(incl. Anglican)

Presbyterian

Methodist, Wesleyan

Protestant

Baptist

Lutheran

Apostolic or Pentecostal

Evangelical

Orthodox(Greek, Coptic, Russian)

Christian Religion

Jehovah's Witness

Jewish

Muslim(Islamic)

Buddhist

Hindu

Agnostic

Atheist

Other Religions

No Religion

NO CONSENT

Hidden

What is your child's religion?

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.

Signature

(Parent/Guardian 1)

Date

Day

Month

Year

Signature

(Parent/Guardian 2)

Date

Day

Month

Year

If Roman Catholic

Date of Baptism if Catholic

Day

Month

Year

Place of Baptism

If not Baptised in Cobh please attach Baptismal Certificate

Max. file size: 2 MB.

Consent Section

Name of Child

First

Date

Day

Month

Year

Permission to provide change of clothes

My child may be given a change of clothes should the need arise.

Yes

Permission for Outings and School Activities Outside of School Grounds

My child may participate in outings and activities outside school grounds.

Yes

Accident and/or Emergency Consent Form

The staff of St. Mary's N.S. Cobh may act on my behalf in case of emergency or accident and may take such action as may be necessary for the benefit of may child.

Yes

Permission to Be Photographed or Video Recorded

My child may be photographed or video recorded during school activities. (Photographs/videos may be used for displays in School, in local and national publications, on school social media and on school website.)

Yes

Permission to Participate in Food Tasting

My child may be given food samples to taste as part of a lesson activity. (It is the responsibility of parents to notify school of any food allergies)

Yes

Permission for Withdrawal from Class

My child may be withdrawn from class in a group or individually for learning or supplementary teaching support and assessment.

Yes

Permission to Consult outside Agencies

The teaching staff and school authorities may consult with outside agencies, if required, on behalf of my child. (Parents/Guardians will be notified).

Yes

Signature

(Parent/Guardian 1)

Date

Day

Month

Year

Signature

(Parent/Guardian 2)

Date

Day

Month

Year