Mount Saint Michael, Rosscarbery

Enrolment Form

25-April-17

ENROLMENT FORM

Please complete each question IN FULL

IMPORTANT:

The Department of Education & Skills operates an electronic database of post-primary school pupils called Post Primary Online Data (PPOD). The information requested below will be uploaded to PPOD and to our own school’s database Vsware.

SECTION 1: STUDENT DETAILS:

Year Group for which you are enrolling:___________________Male: □ Female: □

Student’s Name & Surname (as per Birth Certificate):______________________________

Student’s Christian Name known by (if different):_______________________________________

Date of Birth: ____________________________________________________

Address:________________________________________________________

________________________________________________________________

Student’s PPS Number: ____________________________________________

Nationality:______________________________________________________

Mother’s Maiden Name:____________________________________________

Is the pupil’s mother tongues (i.e. language spoken at home) English or Irish? Yes: □ No: □

Does this student have a Medical Card Yes: □ No: □

Brother(s) and/or sister(s) currently in this school (Name & Year Group) : _______________________

_________________________________________________________________________________________

SECTION 2: FAMILY DETAILS:

MOTHER/GUARDIAN FATHER/GUARDIAN

Christian Name

Surname

Occupation

Mobile Number

This number will be used for WebText

Landline Number (if available)

Work Number

Email Address

This will be used for some correspondance.

SECTION 3: ETHNIC & RELIGIOUS BACKGROUND:

The Information requested in this Section is OPTIONAL.

Do you consent to the information in relation to Religion & Cultural Background being uploaded to PPOD? Yes:□ No:□

Ethnic/cultural background:

To which ethnic or cultural background group does your child belong (please tick one)

(Categories based on the Census of Population)

White Irish  Irish Traveller  Roma  Any other White Background  Black or Black Irish - African  Black or Black Irish - Any other Black Background 

Asian or Asian Irish – Chinese  Asian or Asian Irish - Any other Asian background 

Other (inc. mixed background)  No consent 

Religion: What is your child’s religion?

Roman Catholic  Church of Ireland (Anglican)  Presbyterian 

Methodist, Wesleyan  Jewish  Muslim (Islamic) 

Orthodox (Greek, Coptic, Russian)  Apostolic or Pentecostal  Hindu 

Buddhist  Jehovah's Witness  Lutheran 

Atheist  Baptist  Agnostic 

Christian Religion (not further defined)  Protestant  Evangelical 

Other Religions  No Religion  No Consent 

Section 3: EDUCATIONAL BACKGROUND

Primary School(s) Attended:

Year/s

20_ _ To _ _ ­ _ _

20_ _ To _ _ ­ _ _

Any Known Learning Difficulties? Yes q No q

If answer is ‘Yes’ please give details:

_________________________________________________________________________

Exemption from any subject? Yesq Noq

If answer is ‘Yes’ please give details:

Did Student Receive Special Help In Any Subject? Yes q No q

If answer is ‘Yes’ please give details:

Was an Educational / Psychological Assessment Ever Carried Out? Yesq Noq

If answer is ‘Yes’ please give details:

I give Mt St Michael permission to liaise with the primary school attended along with any other relevant agencies regarding the educational needs of my son/daughter.

Yes q___ No q

ACHIEVEMENTS

INTERESTS / HOBBIES

SECTION 4: HEALTH DETAILS

STATUS

(e.g Good)

Any Known Problems

ADDITIONAL DETAILS

General Health:

Eyesight:

Hearing:

Allergies:

Any existing conditions:

Able To Participate In Physical Education? Yes q No q

If answer is ‘No’ please give details:

Name: Address: Tel. No:

FAMILY DOCTOR: _____________________ ________________

I agree that in the case of an emergency, my son/daughter may be brought to the local doctor’s surgery or hospital if required. Yes q Noq

Has your son/daughter previously attended, or is he/she currently attending any agency which the school should be aware of? Yes q Noq

If Yes which agency? (such as NEPS, HSE, CAMHS, TUSLA, Other) _______________

SECTION 5: PARENT/GUARDIAN SIGNATURES:

Please be advised that by signing below you give consent for the above information to be stored in the school and shared with the Department of Education and Skills as requested.

I/We consent that my son/daughter may from time to time appear in educational, and/or promotional literature such as school noticeboards, newspapers, videos, newsletters, brochures, webpages, etc Yes No

I/We consent that my son/daughter may partake in tours and various other excursions involving travel outside the school grounds during the school year as organised by the school.

Yes No

I/We understand the procedures and policies of the school and with my son/daughter, I/we will endeavour to uphold and support them.

Signed (Parent/Guardian) _________________________________________

Signature of enrolling Teacher:____________________________ Date enrolled: _________________

It is the sole responsibility of Parents/Guardians to inform the school of any changes to the information provided on this form.

We look forward to working with you in the future. Thank You.

Events
Dec
21 2017
Carol Singing for TYS in aid of SIMON
Dec
21 2017
1st Yr Christmas Talent Show
Dec
22 2017
School Christmas Fundraising QUIZ
Jan
10 2018
Young Scientist Exhibition
12-Dec-2017
An unforgettable experience!
11-Dec-2017
Munster semi final success!
07-Dec-2017
Well Done to TY Debaters who defeated Kinsale last night!
06-Dec-2017
Well Done to Alice Buckley-Healy & Marie Keating 5th Year.
Get In Touch
 
 
 
Our Details
Mount Saint Michael
Rosscarbery
Co. Cork
Ireland

023 884 8114

Ceist
Location
© 2017 Mount Saint Michael, Rosscarbery