St. John’s National School AS Class

 Enrolment Application Form

Please complete all of this form, incomplete forms will not be accepted.

Child’s name: ___________________________________

Address: _____________________________________

_____________________________________________

Eircode: _________________________

Date of Birth: _____________________                            Gender: ___________________

P.P.S No: _________________________

Religion: _________________________                            Nationality: ________________

Any medical conditions that the school should be aware of: ______________________

_______________________________________________________________________

Family Doctor: __________________________

Mother’s Name: _____________________________ Ph. No: ______________________

Mother’s Email: ______________________________

Father’s Name _______________________________ Ph. No: ______________________

Father’s Email: _______________________________

Contact Name & phone No. in case of emergencies, (This number must be different from parents)

Name: _____________________________________ Ph. No: _________________________

Please state name and address of previous School, and class your child would be going into if they are changing schools: _____________________________________________________________

_______________________________________________________________________________

Parents/Guardians Signature: _______________________    ______________________________

Date: __________________________

Please ensure the following are enclosed with this Application form.

1. Original Birth Certificate and a photocopy.
2. Two Original documents, as proof of address within the catchment area example: Utility Bills (these must be dated within the last 3 months of application.)
3. A copy of all Psychiatric and/or Psychological Assessments and reports your child has received.