Application for admission of new pupils year 2013/2014 name of child: date of birth
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C onvent 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 INFORMATIONHAS 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 |