Scoil Mhuire na Dea-Chomhairle Phone 061 367289

Kilkishen Email:kilkishennationalschool@gmail.com
Co. Clare Website: kilkishen.weebly.com
Roll Number: 13870E Twitter: @kilkishenns

Enrolment Application Form 2023

Pupil’s First Name: ____________________ Surname: _________________________

Date of Birth: _______________________ Gender: __________________________

Address (at which the child resides):

_________________________________________________________________________

Name and class of Sibling(s) currently enrolled:

__________________________________________________________________________

Parish in which the child resides: _______________________________________________

Parent/Guardian Details:
Mother’s details: Father’s details:

Name: _______________________ Name: _______________________

Parent:__ Custodian:__ Legal Guardian:___ Parent:__ Custodian:__ Legal Guardian:___

Address:__________________________ Address:___________________________

_________________________________ __________________________________

Contact number: Contact number:

_________________________________ __________________________________

Email address: Email address:

_________________________________ _________________________________

Signature 1: ________________________ Signature 2: ________________________

Date: ________________________ Date: _________________________

Return by post or email to the above addresses by Friday January 13 2023.