Newbawn S.H.N.S enrolment

application

Child’s Name:                     __________________________________________________________

(as per State Birth Certificate)

Address:                              __________________________________________________________

  __________________________________________________________

   PPS Number (of child):  _________________________________________

Names of Parents/Legal Guardians: (1) _____________________________________________________

                                                            (2) ____________________________________________________

Address of Parents/Legal Guardians (1) _____________________________________________________

                                                                 ____________________________________________________

                                                                 ____________________________________________________

                                                             (2) ____________________________________________________

                                                                 ____________________________________________________

                                                                  ____________________________________________________

Occupation of Mother/Legal Guardian: ______________________________________________________

Occupation of Father/Legal Guardian: _______________________________________________________

Telephone Numbers:  (Please provide Home, Mobile and Work numbers for both where applicable.)

Mother/Legal Guardian: _____________________________________________________________

Father/Legal Guardian: ______________________________________________________________

Emergency Contact: (Please include name) ________________________________________________________

Name and Address of Previous Primary School (if applicable)

____________________________________________________________________________________________________________________________________________________________________________________

Name and Address of Pre-School (if applicable)

____________________________________________________________________________________________________________________________________________________________________________________

Religion: __________________________________________________________________________________

Church where baptised:  _____________________________________________________________________

_________________________________________________________________________________________

Name and Address of Doctor:

____________________________________________________________________________________________________________________________________________________________________________________

Telephone Number: _________________________________________________________________________

If your child suffers from any allergies, disabilities or medical conditions please provide details below.

Please indicate if your child has been

assessed in any of the following areas.

If so, please furnish the school with a

copy of same, at your earliest convenience.

Collection of Children / Child Protection

It is the policy of SHNS that children may only be collected by the parent(s) / guardian(s) / person(s) nominated on this form.

Before nominating persons to collect their child(ren), parents / guardians are strongly advised that those nominated have Garda Vetting Certificates. Please contact your local Garda Station for further information.

Parents / guardians must notify the Principal / Deputy Principal in writing (normally the Homework Notebook) if changing a “nominated collector” to collect the child(ren).

In the once off event of a neighbour or family member collecting a child, a written note (in Homework Notebook) to the Class Teacher is required. If the situation is urgent, a phone call to the school may suffice.

Please be advised that the “Denominational Character” of Sacred Heart NS (SHNS) is Roman Catholic, and due to constraints of time, space, and personnel, other beliefs may not always be catered for. Catholic iconology is present throughout the school.

…………………………………

The Health Executive Authority requests the name, address, date of birth and telephone number of all the children in our school. The details are required in order to update their records for ophthalmic, dental and hearing tests and appointments.

Under the Data Protection Act we must have your consent to pass on this information.

Do you consent to the school passing this information to the HSE?       YES _______  NO _______

…………………………………

In the unlikely event of a critical incident in the school, the school may organise class support from a counsellor/psychologist from the Health Service Executive or the Department of Education and Skills.

Do you give permission for your child to participate in such a session?  YES ______  NO_______

…………………………………

In the event of a serious illness / accident to my child (if I cannot be contacted)

I give permission for him / her to receive medical attention.                 YES ______   NO _______

Signed _____________________________________       Date ________________________

Please be assured that all information on this form is private and confidential.

The BOM Sacred Heart NS will inform you in writing within 21 days of their decision concerning this application for enrolment.