Office use only

Register No.
Birth Cert received:
SCOIL RÉALT NA MARA Baptismal Cert rec/d:
CROMANE, KILLORGLIN, CO. KERRY
PHONE: 0669769331. EMAIL: info@cromanens.com

ENROLMENT APPLICATION FORM

PUPIL’S FIRST NAMES -------------------------------------------------

PUPIL’S SURNAME -------------------------------------------------

PUPIL’S FORENAME AS ON BIRTH CERT -------------------------------------------------

PUPIL’S SURNAME AS ON BIRTH CERT -------------------------------------------------

DATE OF BIRTH: ----------------------------- P.P.S. N. of pupil --------------------------

ADDRESS -------------------------------------- -------------------------------------------------

FATHER’S NAME ------------------------------ MOTHER’S NAME: ----------------------

ADDRESS --------------------------------------- ADDRESS: ---------------------------------

(if different from pupil’s)

OCCUPATION ----------------------------------- OCCUPATION: ---------------------------

PHONE ------------------- WORK --------------- PHONE ------------------ WORK-----------

MOBILE ----------------------------------- MOBILE ------------------------------------

EMAIL: ----------------------------------- EMAIL: ------------------------------------

FORMER PRE-SCHOOL -------------------------------------------------

/FORMER SCHOOL & CLASS ----------------------------------------

---------

NATIONALITY --------------------------- MALE/ FEMALE (PLEASE CIRCLE)

RELIGION ------------------------------------ Mother’s Maiden Name -------------------

Is one of the pupil’s mother tongues (i.e. language spoken at home) Irish or English?
(please circle one) Yes No
I consent for this information to be stored on the Primary Online Database (POD) and
transferred to the Department of Education and Skills and any other primary schools my child
may transfer to during the course of their time in primary school.

Alternative contact numbers (not your own number) in case we cannot contact either parent:

(1) Name: ----------------------------------------------------------------------------------------

1
 SCOIL RÉALT NA MARA
CROMANE, KILLORGLIN, CO. KERRY
PHONE: 0669769331. EMAIL: info@cromanens.com

Phone Numbers: ----------------------------------------------------------------------------

(2) Name: ---------------------------------------------------------------------------------------

Phone Number: ---------------------------------------------------------------------------

NB - Should any of these numbers change while your child is attending this school, please
inform us immediately.

Strictly Private & Confidential:

Family Doctor: --------------------------------------------------- Contact No: -----------------------

If there is anything the school should know about the child, please give details here or talk to
the Class teacher/Principal.

---------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------

● Please attach a copy of both your child’s baptismal certificate AND birth certificate.

SCHOOL WEBSITE
We sometimes celebrate school events by taking photographs and video clips (eg. school garden,
football matches and sports days etc.) and then putting some of these photos on display – in the school,
on our website or occasionally by sending a photo to the local newspapers. Before the school can
display photographs of children, their parents’/guardians’ permission is required. Please indicate your
willingness or otherwise to allow images of your child to be displayed, if the occasion arises. Please
note that children’s names and/or contact details will NEVER be published.
WEB IMAGES PERMISSION

Name of Child/children: ---------------------------------------------------------------

Signature of Parent/Guardian: ---------------------------------------------------------------

Date: ---------------------------------------------------------------

(Please tick one) I consent do not consent

to photo images and video clips of my child/children being displayed in the school, on the
website of Scoil Réalt na Mara (www.cromanens.com) or being published in local
newspapers should the occasion arise. This permission remains valid until my child
completes Sixth Class.