Enrolment Form

1. Name of Child:

Sex of child:MaleFemale

2. Date of Birth:

PPS Number:

Religion:

3. Address:

Parent / Guardian Email address:

4. Mother / Guardian:

Contact Number:

5. Father / Guardian:

Contact Number:

6. Emergency contact name and phone no.:

Second emergency contact name and no.:

7. Mobile no. used for school texting service:

(It is the responsibility of parents / guardians to inform the school if any of the above numbers change,
during the above child’s time in the school)

8. Does your child have or appear to have any difficulties with the following:
HearingVisionSpeech
If yes, please indicate how this (these) may affect your child during the school day:

9. Does your child have any medical condition(s) which the school needs to be aware of:
AsthmaDiabetesEpilepsyPacemakerAllergiesPacemakerNosebleeds
Other:
Please explain how the above may affect your child during the school day:
Please indicate what medication / treatment is required by your child during the school day:

Can your child self-medicate?
YesNo

Does your child require assistance with his/her medication?
YesNo

Can a member of school staff assist your child with his/her medication?
YesNo

10. Do you give the school / member of staff permission to call an ambulance for your child in the case of an emergency?
YesNo

11. Does your child have any learning difficulties that you are aware of? Please describe:

12. If your child has had an assessment please give details:

13. Do you give your child permission to go on local school trips, under teachers / SNA supervision during the school day e.g. local park / local schools / library etc
YesNo

14. Do you give permission for your child’s photograph to be used for school projects, school notice board, local newspaper, and school related activities?
YesNo

15. Do you give permission for your child’s photograph to be used on the school’s web site?
YesNo

16. Please sign to indicate that you are aware that St. Francis SNS or its Board of Management cannot be held responsible for pictures / video taken by / uploaded by parents / guardians / visitors during the school activities or events.
I, , parent/ guardian) have read no. 16.

17. Do you give your child permission to access the internet for educational purposes?
Students are not allowed to access social networking sites or other unsuitable sites at any time, whilst in school.
YesNo

18. I / We have read and accept St. Francis SNS:
YesNo

(These are the short version of the policy / code. Full documents in secretary’s office)
Mobile phone policy:YesNo
S.P. H. E. policy:YesNo
Anti-bullying / discipline policy:YesNo
Internet policy:YesNo

19. My child’s POD details may be transferred from his/her previous school:
YesNo

Name of parent(s) / guardians(s):
Date of agreement:

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.