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Our Lady of the Wayside N.S. Bluebell
Enrolment application form - September 2021
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I have received and read the GDPR Privacy Notice from Our Lady of the Wayside N.S. (available on the policies page of our website)
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Yes
No
I give consent to Our Lady of the Wayside N.S. to process the data I am providing in accordance with general data protection regulation
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Yes
No
Application for (Please tick the class you would like to enrol your child in)
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Choose
Junior Infants
Senior infants
1st Class
2nd Class
3rd Class
4th Class
5th Class
6th Class
Child's name (as on Birth Cert)
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Your answer
Address (where the child resides)
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Your answer
P.P.S. Number (child)
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Child's country of birth
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Your answer
Language spoken at home
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Your answer
Mother's name:
Your answer
Mother's phone number
Your answer
Mother's email address
Your answer
Father's name
Your answer
Father's phone number
Your answer
Father's email address
Your answer
Guardian's name (if applicable)
Your answer
Guardian's phone number (if applicable)
Your answer
Emergency contact name (Please nominate someone to contact in case of emergency if parent/guardian is unavailable
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Your answer
Emergency contact phone number
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Your answer
Religion (If catholic please send a copy of baptismal cert)
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Your answer
Number of children in family
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Your answer
Child's place in family
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Your answer
Sibling in Our Lady of the Wayside
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Yes
No
Other schools or education settings attended (Early start, playschool or primary school)
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Your answer
Details of any illness or medical condition that the school should be aware of
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Your answer
Has your child had their eyes tested?
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Yes
No
Has your child had their hearing tested?
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Yes
No
Has your child ever been referred for assessment?
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Yes
No
If yes, please give details of assessment (If you have copies of any relevant professional reports, we would appreciate a copy for our records to help us meet your child's needs while in school)
Your answer
Any other condition/issues you would like to bring to our attention
Your answer
Please read and tick (if you would like copies of any policies or procedures, please contact the school
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In the event of my child needing supplementary teaching in school, I give my permission for any relevant testing to be administered in school by the learning support/resource teacher
I acknowledge that the mandatory SPHE programme contains elements of substance use/relationships & sexuality education/stay safe & child protection
I give permission for my child's photograph to be taken and displayed for school use
I agree to and support the school's Code of Behaviour
I agree to and support the school's Acceptable Use Policy
I give consent to my child to go on supervised school trips
I give permission for first aid to be administered to my child
I agree to NEPS intervention in the event of a critical incident
I agree to medical intervention in the event of an emergency
Required
Signature of parent/guardian (typed answer will suffice)
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Your answer
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