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Student details

Fore name:

Surname:

Name as on birth cert:

DOB:

Gender:

P.P.S No:

Mother's (guardian) Maiden Name:

Nationality:

Country of birth:

Ethnic background:

English spoken at home:

Address:

Eircode:

Year to enrol:

Primary school:

Height for locker allocation:

Details of Parents / Guardians

Mother's (guardian) name:

Occupation:

Place of work:

Mother's home no:

Mother's mobile no:

Father's (guardian) name:

Occupation:

Place of work:

Father's home no:

Father's mobile no:

Contact email:

Contact mobile no.:

(Only complete below if different than student’s address)

Mother's address:

Father's address:

Other contact in case of emergency

Name:

Phone no:

Contact Details for Legal Guardian or Foster Parent (If relevant)

Select if appropriate:

Name and address:

Mobile no.:

Email:

Medical Details

Doctor's name:

Phone no.:

Address:

Any conditions – emotional/physical/learning that are of relevance to the school:

Is the student on any medication? (if so, please give details):

Is the student physically able to play sport? (if noy, please specify):

Other Information

Sports participated in and level:

Other interests and achievements:

Other information which would be of interest/relevance to the school:

Educational Details (All information given will be treated in the strictest of confidence.)

Primary/Post primary school principal:

Phone no.:

Ever receive Learning Support in Primary School? (if please give details):

Ever receive full Assessment (Psychological or Educational)? (e.g. name of psychologist, date, reason for referral - A copy will be required for our files)?

Irish exemption confirmed? (If yes, a copy will be required for our files):

All students must do Irish unless they have an Official Exemption which gives the date granted and the reason why it was granted.

Family Information

No. children in family:

Position in family:

Any sibling in this school?:

Any sibling previously at this school?:

Consents

Permission to receive urgent information by text message:

I/we will attend all meetings/virtual meetings during 1st year for the benefit of my/our child:

Name and address may be made available to outside agencies for Educational Research or Public Health purposes:

I/we consent for my/our son/daughter’s image to be used in photographs and video for promotional purposes by the school and external agencies eg: Local and National press, Conferences which the school presents at, Social Media, School website, etc:

I/we give consent to screening/diagnostic tests being administered during my/our son/daughter’s time in school to identify and support their learning needs:

The school offers an Educational counselling service, if you do not wish for your son/daughter to participate in any aspect of the program please indicate below which aspects you do not wish them to receive over their time in St. Brendan’s Community School.:

The school offers a Career counselling service, if you do not wish for your son/daughter to participate in any aspect of the program please indicate below which aspects you do not wish them to receive over their time in St. Brendan’s Community School.:

The school offers a Personal counselling service, if you do not wish for your son/daughter to participate in any aspect of the program please indicate below which aspects you do not wish them to receive over their time in St. Brendan’s Community School.:

Certain sensitive data which the Department requests Post Primary schools to furnish via the “Annual Post-Primary School October Returns/Examination entries” process requires your written consent for the school to record this information and for the school to forward this information to the Department for the purposes as outlined in Circular 47/2010 – a copy of which is available on www.education.ie. I/we give my/our consent to this data being forwarded to the Department of Education and Skills:

I/we give our/my consent to the Learning Support and Guidance Departments from St. Brendan’s Community School to collect information, both written and verbal, from my child’s primary school and to discuss contents with SENO if necessary. I/we give our/my consent to the Learning Support and Guidance Departments from St. Brendan’s Community School to receive copies of any professional reports concerning my child’s education and development, provided by the primary school and to discuss contents with SENO if necessary:

Confirmation of application

By filling in this application I/we wish to confirm our intention to enroll student named on this form in St. Brendan’s Community School for the School Year as indicated. I/we further agree to accept the Admissions Policy, Positive Code of Behaviour and Uniform Policy. I/we confirm I/we have read same and the Misson Statement on this school website. I/we give an undertaking that my son/daughter will abide by the Rules and Regulations as set down in the Positive Code of Behaviour

Checklist, please forward the following

Birth Certificate – copy
Recent passport sized photo (can be printed off mobile phone).
Irish Exemption form – if applicable
Psychological or other reports – if applicable.

Application for Enrolment