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Application for admission of new pupils year 2013/2014 name of child: date of birth


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Convent of Mercy N.S.,

Belturbet, Cavan, Co. Cavan.



Tel:- (049) 9522992

email:- info@comns.ie



APPLICATION FOR ADMISSION OF NEW PUPILS YEAR 2013/2014
NAME OF CHILD:- _____________________________________________________

DATE OF BIRTH:- _____________________________________________________

FATHER’S NAME:- _____________________________________________________

MOTHER’S NAME:- _____________________________________________________

MOTHER’S MAIDEN NAME (if applicable) _______________________________________________

MARITAL STATUS:- _____________________________________________________

HOME ADDRESS:- _____________________________________________________

TELEPHONE NUMBER:- _____________________________________________________

RELIGIOUS DENOMINATION:- _____________________________________________________

DATE & PLACE OF BAPTISM:- _____________________________________________________

HAVE YOU SUBMITTED YOUR CHILD’S BIRTH CERTIFICATE YES  NO 

PARENTS OCCUPATIONS:- _____________________________________________________

ANY PREVIOUS SCHOOL ATTENDED:- ________________________________ CLASS ___________

ARRANGEMENTS IF THE CHILD IS ILL IN SCHOOL/EMERGENCY CLOSURE ____________________

NO. OF CHILDREN IN FAMILY:- BOYS _____ GIRLS _____ CHILD’S PLACE IN FAMILY _______

DO YOU GIVE PERMISSION TO TAKE THE CHILD STRAIGHT TO HOSPITAL IN CASE OF SERIOUS ILLNESS OR ACCIDENT? YES  NO 
NAME OF FAMILY DOCTOR:- _______________________________ PHONE NO. _______________

DOES ANY LEGAL ORDER UNDER FAMILY LAW EXIST THAT THE SCHOOL SHOULD KNOW ABOUT _________________________________________________________________________________

ANY OTHER INFORMATION REGARDING YOUR CHILD WHICH YOU THINK THE SCHOOL SHOULD KNOW. (CAN BE COMMUNICATED VERBALLY TO CLASS TEACHER/PRINCIPAL IF YOU WISH).
_________________________________________________________________________________

DO YOU GIVE CONSENT FOR YOUR CHILD’S PHOTOGRAPH/D.V.D TO BE TAKEN DURING SCHOOL ACTIVITIES (Please Tick as appropriate) YES  NO 
DO YOU GIVE CONSENT FOR YOUR CHILD’S PHOTOGRAPH TO BE TAKEN AND/OR USED ON OUR WEBSITE (Please Tick as appropriate) YES  NO 
Do you give your permission for your child to go to the town hall/GENERAL OUTINGS accompanied by their class teacher FOR SCHOOL RELATED ACTIVITIES

(Please Tick as appropriate) YES  NO 
DO YOU GIVE PERMISSION FOR YOUR CHILD TO FOLLOW THE SCHOOL’S ACCEPTABLE USE POLICY ON THE USE OF THE INTERNET? THE INTERNET WILL ONLY BE USED FOR EDUCATIONAL PURPOSES. (Please Tick as appropriate) YES  NO 
_________________________________________________________________________________

ANY OTHER USEFUL INFORMATION



HAS YOUR CHILD HAD HIS/HER HEARING TESTED? (Please Tick as appropriate) YES  NO 

IF YES WHAT WERE THE RESULTS: __________________________________________________
HAS YOR CHILD ATTENDED A SPEECH AND LANGUAGE THERAPIST?

(Please Tick as appropriate) YES  NO 



IF YES GIVE DETAILS: ____________________________________________________________

________________________________________________________________________________


HAS YOUR CHILD ANY ILLNESS/ALLERGY SCHOOL SHOULD BE INFORMED OF?

(Please tick as appropriate) YES  NO 

IF YES GIVE DETAILS: _____________________________________________________________
HAS YOUR CHILD ANY OTHER DIFFICULTIES OR PROBLEMS?

(Please Tick as appropriate) YES  NO 
IF YES GIVE DETAILS: ___________________________________________________________
________________________________________________________________________________

As part of the SPHE subject, the Stay Safe Programme will be taught to all children every 2nd year in this school. Parents/Guardians will be notified in advance of commencement of programme.
If in the future, it is felt that your child would benefit from diagnostic testing to ascertain if he/she requires learning support, we request your signature & consent below.
SIGNATURE: ___________________________________________ YES  NO 
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 will co-operate with the staff and support the ethos of the school.

Signed:- ______________________________ Parent/Guardian.


Date:- ______________________________ 2013/2014



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