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Applicant details

Enrolment Year:

Enrolment Class:

Surname:

First name:

Second name:

Home address:

Town:

County:

EirCode:

Second address:

DOB:

Gender:

P.P.S No.:

Is this application for a position in our Autism Class:

Details of Parents / Guardians

Mother's (guardian) name:

Mother's maiden name:

Mobile No:

Home No:

Father's (guardian) name:

Mobile No:

* Please specify the mobile number & email address you wish to receive text messages and emails from school (note it must be parent/guardian’s number or email).

Contact Mobile No:

Contact Email:

Names of any siblings in this school:

Medical History

Any conditions – emotional/physical/learning that are of relevance to the school:

Has your son/daughter any physical problems which may need regular medical attention e.g. asthma, epilepsy etc:

If the student taking any medication that would have to be kept in school, please give details:

Doctor's name:

Doctor's Phone No.:

Do you or your child hold a medical card:

In case of emergency

Emergency name:

Relationship:

Mobile No.:

Home No.:

Work No.:

Educational History

Present school:

Class / Teacher:

School address:

Phone:

School principal:

School roll no. (obtained from school):

Exempt from Irish? (if yes, please submit copy of Exemption Certificate):

Is your son/daughter receiving any additional learning support?:

Any other relevant information e.g. psychological reports:

Any Other Information

Other interests and achievements:

Other information, which would be of interest/relevance to the school:

Consent

Certain sensitive data which the Department requests post-primary schools to furnish via the “Annual Post-Primary School October Returns/Examination Entries” process requires your written consent for the school to record this information and for the school to forward this information to the Department for the purposes as outlined in circular 47/2010 a copy of which is available at www.education.ie

I consent to information being shared/forwarded to the Department of Education and Skills and where appropriate with class teachers.
I consent to information being collected from my son/daughters previous school in relation to their education.
I consent to screening/diagnostic tests being administered during my son/daughters time in school to identify and support their learning needs.
I consent for my sons/daughters image to be used in photographs and video for internal Vs Ware identification, promotional purposes by the school and external agencies eg: Local and national press,
I consent to St. Laurence College to allow my daughter supervised access to the school’s computer systems, the internet and her school email in line with the Internet and ICT Acceptable Usage Policy (HYPERLINK) and understand that access to the School’s Computer Systems are designed for educational purposes only:

The schools offers a full counselling service, if you do not wish for your child to participate in any aspect of the program please indicate below which aspects you do not wish them to receive over their time in St Laurence College:

Confirmation of application

By filling in this application we wish to confirm our intention to enrol our student listed above in St Laurence College for the School Year as indicated. We further agree to accept the Admissions Policy and the Code of Behaviour as found on our school policies page.

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Application for Enrolment