Expression of Interest Form

SONRAÍ AN PHÁISTE ( Child's Details)

Ainm (Name)(Required)

Sloinne (Surname)(Required)

Inscne ( Gender )

Dáta Breithe ( Date of Birth)(Required)

Uimhir PPS ( PPS Number)(Required)

Náisiúntacht ( Nationality )

Scoil roimhe seo (Previous school)

An bhfuil siblín(Í) sa scoil cheana féin? (Is there a sibling in the school?)

TÁ ( YES )

NÍL ( NO)

Sonraí Clainne (Family Details)

Guthán ( Home phone number)(Required)

Fón Póca ( Mobile number)

Seoladh ( Address )(Required)

Éirchód (Eircode)(Required)

Caomhnóir 1 ( Guardian 1)

Ainm (Name)(Required)

Ainm Shloinne ( Surname)(Required)

Seoladh Rphost (email)(Required)

Fón Póca (Mobile number)(Required)

Uimhir oibre ( Work number)

Caomhnóir 2 (Guardian 2)

Ainm (Name)(Required)

Ainm Shloinne ( Surname)(Required)

Seoladh Rphost (email)(Required)

Fón Póca (Mobile number)(Required)

Uimhir oibre ( Work number)

Teagmhálaí Éigeandála (Emergency contact)

Emergency Contacts

Ainm (Name)

Gaol (Relationship)

Fón Póca (Mobile number)

Uimhir oibre ( Work number)

"+" to add additional line

LEIGHIS

An bhfuil do pháiste ag tógaint aon leighis ? ( Is your child taking any medicine on regular basis?)

Má tá tabhair níos mó eolais dúínn ( If YES, please provide details)

An gcaithfidh do pháiste leighis a thógaint i rith am scoile? (Is your child required to take medicine during school hours?)

Má caithfidh, b'eigean duit litir a scríobh chuig an Phríomhoide ag rá go bhfuil an páiste freagrach as agus ní bheidh aon locht ar an múínteoir an leighis a eagrú má tharlaíonn aon eachtra. (If so you are required to give a written statement to the Principal stating that the child is responsible for his/her own medicine and that the class teacher will not be held responsible for the administration of the medicine or for any consequences that may arise.)

An bhfuil ailléirge ag do pháiste le rud ar bith? ( Is your child allergic to amything?)

Má tá tabhair níos mó eolais dúínn ( Please provide details)

SONRAÍ AN PHÁISTE ( Child's Details)

Sonraí Clainne (Family Details)

Caomhnóir 1 ( Guardian 1)

Caomhnóir 2 (Guardian 2)

Teagmhálaí Éigeandála (Emergency contact)

LEIGHIS

”Is Gael mise, nach uasal sin”