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baltydaniel national school – enrolment form

Baltydaniel National School Newtwopothouse, Mallow Ph.: 022-42646 - e-mail: [email protected] www.baltydanielns.ie
Child Details
Child’s Name: _________________________ Date of Birth__________________
(Please attach copy of birth certificate) Address: ____________________
Nationality: ____________
Religion: ________________
(Please attach copy of baptismal certificate)
Previous School or Playschool attended: _______________
Number of children in family: ______
School Bus Route Yes____ No____

Parents/Guardians


Communication from the school will be received through this email address:______________________
Health
Family Doctor: _________________Phone No: ___________Medical Card Holder? Yes___ No____
Has your child ever attended (a) Speech Therapist (b) Occupational Therapist (c) Psychologist (d) Counselling (e) Other (give details) _________________________________ If ‘yes’ a copy of reports should be given to the school. Most recent appointment: Date: ____________________ Is your child allergic to penicillin/any medication/food/other ? Yes____ No____ If yes please indicate_________________________ Note other illnesses ____________________________
Contact Details
Name any other person who has your permission to collect your child during school hours.
_________________________________________________________________
It is essential that we have a phone number of someone we can contact in an emergency, if you are not
available.
Name

Should any of these numbers change, please inform us immediately.
Consents
1. In the event of an emergency, should we fail to contact you, do you give permission to bring your child
to the doctor/hospital? Yes________ No_______
2. Do you agree to have your child treated by school staff for minor cuts, scratches or bruises?
Yes _________ No __________
3. Do you give permission for your child to participate in school trips eg. walks, school tours etc.?
Yes ________ No________
4.Do you allow your child to use the internet in school and accept the school rules on this matter? (see
School Internet Usage Policy on school website)
Yes ________ No________
5. Do you give permission for your child’s work and photographs to be put on the school website?
Yes _________ No __________
6. Do you give permission for newspapers/magazines/school to publish photographs that may include
your child? Yes _______ No __________
The Board of Management cannot be responsible for pictures/videos taken by parents at school
celebrations, school outings, concerts.
I certify that the information I have given in this form is correct.
I confirm that I have read a copy of the Code of Behaviour Policy. (see school website for details)
and agree that the pupil enrolled herewith will be subject to this code.
I further undertake that he/she will comply fully with all School Rules in Baltydaniel N.S.
Parents/Guardian
Signature(s) _______________________________________________Date___________
Please return this form to the Principal, with a copy of your child’s Birth Certificate and Baptismal
Certificate.

Source: http://baltydanielns.ie/wp-content/uploads/2012/09/enrolmentForm.pdf

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