Enrolment Form | St. Brigid’s National School | Laragh

Note: All forms must be completed in full and returned to the school, along with a copy of a birth certificate. Completion of this form does not guarantee your child a place in the school.

Name of Child (in full, as on Birth Certificate) *

First

Last

Address at which child resides (including eircode) *

Date of Birth *

PPS Number *

Number of brothers *

Number of sisters *

Place in family *

Nationality *

1st Language *

Father’s Name *

First

Last

Place of Work *

Mobile Number *

Work Landline Number *

Email *

Mother’s Name *

First

Last

Place of Work *

Mobile Number *

Work Landline Number *

Email *

Guardian’s Name (If applicable)

First

Last

Place of Work

Mobile Number

Work Landline Number

Do any family circumstances or legal order under family law exist that the school should be aware of? *

Emergency Contact - if Parent/Guardian cannot be contacted. (Persons to be aware of this) *

Name *

First

Last

Addresss *

Mobile Number *

Relationship to child *

(e.g. granny/uncle/neighbour)

Did your child attend preschool? *

Name of School *

For how long? *

Other schools attended *

(If transferring from another school)

If this school was a primary school - give your reasons for leaving this school

Give details of any health conditions (e.g. asthma, eyesight, hearing, allergies, etc.) or emotional problems which may affect your child at school

Has your child special needs? (physical, psychological, emotional, educational, that means they require any extra assistance/equipment at school)

Has your child ever had a psychological assessment? *

If yes, please give some details

Has your child ever received a speech and language report? *

If yes, please give some details

I give permission to allow my child’s photograph/image to be included in school-related activities, competitions etc.

Parent / Guardian Signature *

First

Last

I give permission to allow my child to go out of the school under staff supervision for the purpose of school activities e.g. Church visits/nature walks etc. and for my child’s photograph/school work to be published on the school website.

Parent / Guardian Signature *

First

Last

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