It is the parent/guardian's responsibility to read and complete this form carefully.

If you change your mobile phone number, address, or if there is any major change in who your child lives with, it is in your child's best interest to update the school.

All information will be treated with the utmost discretion. Thank you for your cooperation.

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* 1. Child's First Name

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* 2. Child's Surname

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* 3. Please enter your child's first name as it appears on their Birth Certificate (if different from above)

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* 4. Please enter your child's surname as it appears on their Birth Certificate (if different from above)

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* 5. PPSN

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* 6. Date of Birth

Date

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* 7. Nationality

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* 9. Previous school attended (if applicable)

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* 10. Contact Details

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* 11. Details of Family Doctor

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* 12. Does your child have any health-related issues, such as serious allergies, epilepsy, diabetes, asthma, fainting etc? If yes, please detail below.

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* 13. Details of Parent/Guardian No 1

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* 14. Medical Card Number

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* 15. Social Welfare Number

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* 16. Details of Parent/Guardian No 2

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* 17. In the case of an emergency, if Parents/Guardians cannot be contacted, please provide details of adults who can accept responsibility for your child

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* 18. Please tick the boxes below if you agree to the following:

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* 19. Does any legal order under family law exist that the school should know about? (If yes, please email a copy at your convenience)

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* 20. Do you consent to uploading data relating to your child's religion to POD (Department Database)

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* 22. Do you consent to uploading data relating to ethnicity to POD (Department Database)

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* 23. Is one of the pupil's mother tongues (i.e. the language you speak at home in your house) Irish or English?

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* 24. Do you consent to uploading relevant data on this form to POD and Aladdin?

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* 25. Signature of Parent/Guardian 1

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* 26. Signature of Parent/Guardian 2

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* 27. Date Completed

Date
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100% of survey complete.

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