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St. Michael's National School Enrolment Form
This is an application for admission of new pupils in September 2022.
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* Indicates required question
Name of Child
*
Your answer
Birth Certificate Name (if different name to above)
Your answer
Gender
*
Male
Female
Home Address
*
Your answer
Eircode
*
Your answer
Date of Birth (D.O.B)
*
Your answer
Nationality
*
Your answer
Child's Personal Public Service (PPS) number
*
Your answer
Relevant school information (e.g. pupil attendance, progress etc.) to be shared with..
*
Both Parents
Mother
Father
Father's Name
*
Your answer
Mother's Name
*
Your answer
Mother's Maiden Name
*
Your answer
Mother's/Father's Address if different
Your answer
Mother's Contact Number (Please include Mobile, Home and Work Numbers)
*
Your answer
Mother's Email Address
*
Your answer
Father's Contact Number (Please include Mobile, Home and Work Numbers)
*
Your answer
Father's Email Address
*
Your answer
Other Contact Numbers
Your answer
Name(s) of Brothers/Sisters in the School
Your answer
Family Doctor Name and Contact Number
*
Your answer
Please make us aware of any Health Problems (asthma, allergies, hearing, eyesight etc.) and if any medication is required. Please note ALL medications will be kept in the General Office.
Your answer
Medical Card Holder
*
Yes
No
How will your child be travelling from school? NOTE: Please inform the school by letter if your child is travelling on the bus.
*
Bus
To be Collected
Name of nominated person (s) to collect your child from school and contact number.
Your answer
Has your child been assessed by a Speech and Language Therapist?
*
Yes
No
Has your child any problems with speech and language?
*
Yes
No
Is your child receiving the services of a Speech and Language Therapist?
*
Yes
No
Do you have a Speech and Language Report? If yes, please supply the school with a copy of the report.
*
Yes
No
Does your child attend Enable Ireland?
*
Yes
No
If you answered yes to the previous question, please state for what service, e.g. Speech & Language, Occupational Therapy, Physiotherapy? Please supply the school with a copy of the report.
Your answer
Name of Child's Playschool
Your answer
Any other relevant information about your child
Your answer
What is your child's religion?
*
Choose
Roman Catholic
Church of Ireland
Presbyterian
Methodist, Wesleyan
Jewish
Muslim (Islamic)
Orthodox
Apostolic/ Pentecostal
Hindu
Buddhist
Jehovah’s Witness
Lutheran
Atheist
Baptist
Agnostic
Other Religion
No Religion
No Consent
Place of Baptism NOTE: Please supply the school with a copy of your child's birth certificate and baptismal certificate.
Your answer
To which ethnic or cultural background group does your child belong (please tick one)?(Categories are taken from the Census of population)
*
Choose
White Irish
Irish Traveller
Roma
Other White Background
Black African
Other Black Background
Chinese
Other Asian Background
Other (incl. mixed background)
No Consent
If previously in attendance at another national school, please give the following details. Name of School, School Address, Period spent in attendance, Class in which your child was enrolled at the date of leaving.
Your answer
Any other relevant information on the child.
Your answer
I agree to cooperate with the staff and support the ethos of the school.
*
Yes
No
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