Gaelscoil Mhachan.:
Foirm Iarratas Gnáth Rang
Ainm an linbh/Child’s full Name:…………………………………………………
Dáta breithe/Date of Birth:……………… Date of Entry to School:………………..
Ait breithe/Place of Birth:…………….. Place in Family:………P.P.S….………………
Names and classes of other children in family attending this school…………..
………………………………………………………………………………
Creideamh/Religion:……………………..
Rang /Class child will attend:………………………………………………………
Seoladh Baile/Home Address:…………………………………………………Eircode…………..
Child lives with: both parents mother father guardian
Teil/Telephone Number:……………………Email address for school contact……………….………..
Father’s Name:………………………...Mother’s Name:………………………..
Father’s Occupation:……………………….Telephone No……………………
Fathers email address: ………………………
Mother’s Occupation:………………………Telephone No…………………..
Mothers email address : …………………………
Did the child attend school previously (nursery, naíonra, primary school )
Principal’s / Organiser’s Name:………………………..
Name and Address of School your child is attending at present: …………………………….………………………………………………….
…………………………………………………………………………………
Aon riachtanaisí speisialta ag do phaiste/Does your child have any special needs:…………………
Please give details:and please provide professional report:…………………………………………………………….
…………………………………………………………………………………
Is the child weak in any of these areas and give full details where necessary:
Sight Hearing Speech Liver Limbs Co-ordination
Did the child suffer from any of the following illnesses – give full details where necessary:-
Bronchitis Meningitis Adenoids Tonsilitis
Epilepsy Asthma Scarlet Fever Chest / Throat illness
Is the child allergic to any medicine eg. Penicilin, Antiseptic
……………………………………………………………………………………..
Any further details:………………………………………………………………...
……………………………………………………………………………………….
Arrangements in case of emergency :-
In the event that it becomes necessary to send your child home early (e.g. illness, accident, school closure) and that we are unable to contact you at home, please give two other Names, addresses telephone numbers, that can be used (neighbour, relative, friend, etc) you are requested to ensure:
(a) That the people you nominate are aware of this arrangement and are satisfied with it.
(b) That the people nominated live near the school.
Name Address Telephone
A……………………………………………………………………………………
B……………………………………………………………………………………..
Family Doctor…………………………………………….
Address…………………………………………………..Telephone…………………
Eolas eile:Any other information about the child or family which would help
the child’steacher……………………………………………………………………….
…………………………………………………………………………………………..
