Name of Child: __________________________________________________________

Address: _________________________________________________

Eircode: —————————————————————————

P.P.S. No: ________________________________________________

Date of Birth: ______________________________________________

Parent(s)/Guardian(s): ________________________________________

Mother’s Maiden Surname: ____________________________________

Phone No. Home: ___________ Work: __________ Mobile: _________

Religious Denomination: _______________________________________

Date & Place of Baptism: _______________________________________

Any Previous School Attended: ___________________________________

____________________________________ Class: __________ (that school)

Arrangements to be made if the child is ill in school: ___________________

______________________________________________________________

Name of Family Doctor: __________________________________________

Irish Version of Child’s Name: _____________________________________

Do you give permission for your child to be taken straight to hospital in case of serious illness or accident? _________________________________________

Does any legal order under family law exist that the school

should know about?

_______________________________________________________________

Have you attached (a) Birth Cert. ________ (b) Baptismal Cert: ___________

Any other useful information

For example: List any problems the child may have in relation to

Health (allergies, epilepsy, asthma, sight, hearing, speech, fainting etc.)

Toilet training.

Inability to copy with buttons, laces 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 whose custody the child should not be given.

________________________________________________________________

We have received and read a copy of the school’s Code of Discipline.

We will co-operate with the staff and support the ethos of the school.

Signed: ___________________________ (Parent/Guardian)

Date: ___________________________

Ballyconneely National School

Enrolment Application 2004/2025

Name of Child: __________________________________________________________

Any other useful information

For example: List any problems the child may have in relation to

We will co-operate with the staff and support the ethos of the school.