Phone: 068-40293
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Dromclough N.S.,
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APPLICATION RE. ENROLMENT 2022: Junior Infants only
Pupil's Full Name :__________________________________________(as on birth cert) PPS No:________________
A copy of child's Birth Certificate must accompany this form & will be retained in the school file.
A copy of child’s Baptismal Certificate (if applicable) for the receiving of the sacraments of First Holy Communion & Confirmation.
Christian Name by which child is known :_____________________________ Place in Family:__________________
Date of Birth : __________________ Nationality: ______________Church (or Parish) of Baptism:_______________
Address :__________________________________________________________________ Eircode: ____________
Mothers Mobile No:______________________________ Father’s Mobile No:________________________________
Email addresses: Mother:________________________________ Father:_________________________________
Mother's Maiden Name :_____________________________ Father's Name:________________________________
Mobile No. for text-a-parent___________________________
Any previous schools attended :___________________________________________________ Class:____________
Pre-school attended:_____________________________________________________________________________
Name of Family Doctor :__________________________________________________________________________
Your child may be brought to Doctor or hospital in the event of emergency.
Does your child have any medical condition(s)? _______ If Yes, please identify _____________________________
Any other important information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is your child on any long-term medication? Y/N. . . . . . . . . If Yes, specify . .. . . . . . . . . . . . . . . . . . . . . . . . . . .
Has child attended the Brothers of Charity, Enable, KIDS or any other disability services : Yes { } No { }
If Yes, Please give details: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . **
Has your child attended a Speech & Language or Occupational Therapist? Y/N_____ Where/Whom?_____________
Names & ages of any younger brothers & sisters: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
N.B. Persons who may be contacted if child becomes ill at school and parents are unavailable :-
Name :___________________________________ Name :__________________________________________
Address :__________________________________ Address :________________________________________
Phone No:_________________________________ Phone No:_______________________________________
If any details on this form should need to be updated or changed during your child's attendance at school please notify the Principal.
Acceptance for enrolment requires that parents and pupils accept and comply with school policies.
Signature of Parent/Legal Guardian:__________________________________________ Date :_________________
Please return, with certificates, by Thurs. 9th Dec. 2021.
** If required, continue overleaf or on a second sheet.
Pupil's Full Name :__________________________________________(as on birth cert) PPS No:________________
A copy of child's Birth Certificate must accompany this form & will be retained in the school file.
A copy of child’s Baptismal Certificate (if applicable) for the receiving of the sacraments of First Holy Communion & Confirmation.
Christian Name by which child is known :_____________________________ Place in Family:__________________
Date of Birth : __________________ Nationality: ______________Church (or Parish) of Baptism:_______________
Address :__________________________________________________________________ Eircode: ____________
Mothers Mobile No:______________________________ Father’s Mobile No:________________________________
Email addresses: Mother:________________________________ Father:_________________________________
Mother's Maiden Name :_____________________________ Father's Name:________________________________
Mobile No. for text-a-parent___________________________
Any previous schools attended :___________________________________________________ Class:____________
Pre-school attended:_____________________________________________________________________________
Name of Family Doctor :__________________________________________________________________________
Your child may be brought to Doctor or hospital in the event of emergency.
Does your child have any medical condition(s)? _______ If Yes, please identify _____________________________
Any other important information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is your child on any long-term medication? Y/N. . . . . . . . . If Yes, specify . .. . . . . . . . . . . . . . . . . . . . . . . . . . .
Has child attended the Brothers of Charity, Enable, KIDS or any other disability services : Yes { } No { }
If Yes, Please give details: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . **
Has your child attended a Speech & Language or Occupational Therapist? Y/N_____ Where/Whom?_____________
Names & ages of any younger brothers & sisters: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
N.B. Persons who may be contacted if child becomes ill at school and parents are unavailable :-
Name :___________________________________ Name :__________________________________________
Address :__________________________________ Address :________________________________________
Phone No:_________________________________ Phone No:_______________________________________
If any details on this form should need to be updated or changed during your child's attendance at school please notify the Principal.
Acceptance for enrolment requires that parents and pupils accept and comply with school policies.
Signature of Parent/Legal Guardian:__________________________________________ Date :_________________
Please return, with certificates, by Thurs. 9th Dec. 2021.
** If required, continue overleaf or on a second sheet.