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Scoil

Chill

Ruadháin

Brooklodge National School, Glanmire, Co Cork,
Tel: 021-4866044, Fax: 021-4866051, e-mail: scr@brooklodgens.net, Website: www.brooklodgens.com

Expression of Interest
in Enrolling in Scoil Chill Ruadháin for
September 20_____
Name of Child: _________________________________________________________________________
Address: ________________________________________________________________________________
Date of Birth:_______________________________________________________________
Place of Birth :__________________________________________________________________________
Parents’/Guardian’s Name(s):_________________________________________________
Telephone Number (Land-Line):______________________________________________
Mobile Number:____________________________________________________________
Siblings already attending Scoil Chill Ruadháin:_________________________________

Please tick if no sibling is in this school

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Any information, medical or otherwise, regarding the child which may be relevant to the school

________________________________________________________________________________
______________________________________________________________________
Signature of Parent(s) :_______________________________________________________
Date:_______________________________