St. Patrick’s National School

St Patrick’s Rd, Wicklow Town, Co. Wicklow

Roll Number 15676S

0404 67415

Website: www.stpatsnswicklow.ie Email: stpatswicklow@gmail.com

Application Form

Name of Pupil: ___________________________ P. P. S. Number: ___________________________

Date of Birth: _________________________ Male □	Female □

Nationality of Child: __________________

Address: ___________________________________________________________________

Home Telephone Number: _______________	Mobile: ______________	Email: ______________________

Class in which child will be enrolled __________ Date child will first attend: ____________

Age of child on first day in St Patrick’s NS: Years…………… Months……………

Former School:________________________________________ Class: ____________________

Father’s Name: _________________	Mother’s Name: _________________

Father’s Nationality _________________________ Mother’s Nationality ____________________________

Address ____________________________________ Address ____________________________________

(If different from pupils)	(If different from pupils)

_____________________________________________ ____________________________________________________

Occupation (Optional)______________________________	Occupation (Optional)______________

Phone ________________Work _____________	Phone ____________________Work _______________

If other members of the family already attend St. Patrick’s NS please state:

Name _______________________________	Class ______________________________________

_______________________________	___________________________________________

Copy of Birth Certificate □ as per Department of Education & Science Ruling

Status: Married ( ) Single ( ) Separated ( ) Widowed ( ) Other ( )

Contact Numbers

We make every effort to ensure the safety of your child; we may need to contact you in the event of an accident or an unexpected closing.

TEXTAPARENT: St Patrick’s NS contacts parents / guardians of our pupils by text message.

Please include your preferred number for receiving text messages here: ________________________

Alternative Contact Numbers (not your own number). Please let us know if this person is a relation, minder, friend of family etc.

(1) Name ______________________ Relationship to child _________________________

Address ____________________________________________________________

Phone Numbers _________________

(2) Name ______________________ Relationship to child _________________________

Address ____________________________________________________________

Phone Numbers _________________

(3) Name ______________________ Relationship to child _________________________

Address ____________________________________________________________

Phone Numbers _________________

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

In the event of an emergency, should we fail to contact you, do you give permission to the School to bring your

child to doctor/hospital?

Yes:	No:

Signed: _______________________	Date: _______________________________

Please make the above arrangements clear to your child.

Family Doctor ______________ Family Dentist __________________

Educational Screening Test

During your child’s time in St Patrick’s Ns, she/he will undergo various Educational Screening Tests.

Should my child require educational screening testing during his/her time in St Patrick’s Ns I give permission for these tests to be carried out.

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Code of Behaviour

Child’s Name: _______________________________________________

I undertake to support, cooperate and carry out St Patrick’s Code of Behaviour and other policies in the interest of and welfare of the whole school community. My child will wear the school uniform and on P.E. days will wear the school tracksuit. I further undertake to change the details on this form if and when the need arises.

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Ancillary Costs

I understand that there will be certain costs relating to my child’s education in St. Patrick’s NS. These materials will be mainly in the area of books, book rental, educational equipment and materials.

I agree to pay these costs:

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Internet Permission

I have read the AUP (Acceptable Use Policy) on the website and grant permission for my child to access the internet. I understand that school internet usage is for educational purposes only and that every reasonable precaution will be taken by the school to provide for online safety. I accept my own responsibility for the education of my child on issues of Internet Responsibility and Safety. I understand that having adhered to all the enclosed precautions, the school cannot be held responsible if my child tries to access unsuitable material

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Photographs of Students

The school maintains a database of photographs of school events held over the years. It has become customary to take photos of students engaged in activities and events in the interest of creating pictorial as well as historical record of life at the school. Photographs may be published on our school website or in brochures, yearbooks, newsletters, local and national newspapers and similar school related productions. In the cases of website photographs, students’ names will not appear on the website as a caption to the picture. If you or your child wish to have his/ her photograph removed from the school website, brochure, yearbooks etc. at any time, you should write to the school principal.

Consent:

If you are happy to have your child’s photograph taken as part of school activities and included in all such records, tick here. □

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Stay Safe and RSE Programmes

I understand that participation in the Stay Safe and RSE programmes is compulsory and accept my child’s participation in both.

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Other Permission Slips

Do you give permission for your child to go on school trips under teacher supervision during the school day e.g. trips to the local town park, local historical buildings etc. Yes/ No

Do you give permission for your child to partake in School Completion Programme activities and/ or interventions? Yes/ No

Sometimes journalists visit our school to take pictures of the children e.g. awards/prizes, sporting events, first day at school etc. Do you give permission for your child to be photographed for school projects, local newspapers, and school related activities? Yes/ No

The Board of Management cannot be held responsible for pictures/video taken by parents at the Celebrations, School Concert etc.

Sometimes the school is requested to pass on names of children and their addresses to the Health Board for immunisation purposes, to secondary schools when children are transferring to second level, to sporting bodies when children are taking part in games outside the school, to the parish for sacraments, masses etc. Do you allow the school to pass on this information to these four bodies? Yes/ No

Do you give permission to your child to attend the Learning Support or Resource Teacher, if deemed necessary? Yes/ No

Data Protection Statement

Personal Data on this Form

St Patrick’s NS is a data controller under the Data Protection Acts, 1988 and 2003. The personal data supplied on this Enrolment Form is required for the purposes of:

Student enrolment

Student registration

Allocation of teachers and resources to the school

Determining a student’s eligibility for additional learning supports

School administration

Child welfare (including medical welfare)

And to fulfil our other legal obligations

School Contacting You

Please confirm if you are happy for us to contact you by Aladdin SMS/ text message, to call you on the telephone numbers provided and to send you emails in relation to:

Sports days

Parent Teacher Meetings

School events

School closures (due to adverse weather/ training etc.)

Non-attendance, late attendance or other issues relating to your child’s conduct in school

Communication in relation to child’s social, emotional and educational progress and to

contact you in the case of an emergency

Tick box if ‘yes’ you agree with these uses

Use your email address to alert you to these issues?	□

Use your mobile phone number to send you SMS texts to alert you to these issues?	□

Use your mobile phone/ landline number to call you to alert you to these issues?	□

Please note: St Patrick’s NS reserves the right to contact you in the case of an emergency relating to your child regardless of whether you have given your consent

While the information will generally be treated as private to St Patrick’s NS and will be collected and used in compliance with the Data Protection Acts 1988 and 2003, from time to time it may be necessary for us to transfer your personal data on a private basis to other bodies (including the Department of Education and Skills, the Department of Social Protection, An Garda Síochána, the HSE, Tusla, social workers, medical practitioners, the National Educational Welfare Board, National Educational Psychological Service, National Council for Special Education/Special Education Needs Officer and other schools when transferring. We rely on parents/ guardians and students to provide us with accurate and complete information and to update us in relation to any changes in the information provided. Should you wish to update access to your child’s personal data, you should write to the school principal requesting an Access Request Form

Consent

I consent to my child’s data being collected, processed and used in accordance with the Data Protection Legislation commencement date 25th May, 2018 during the course of their time as a student in the school.

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

Please note: a full copy of the Data Protection Policy is available from the office

Child Profile

(For school records only)

Family

Child’s Name: _______________________________________

Is your child living with (circle appropriate): Both Parents	One Parent	Grandparents	Carers Other

Who are the legal guardians of your child? ________________________________________

If there is any relevant legal documentation we should have please give details and supply a copy e.g.

Guardianship, Barring Orders, Access etc. _________________________________________________________

___________________________________________________________________________________________

Medical/ Educational

Medical conditions we should know about: - Please tick.

1. Speech [ ] Hearing [ ] Sight [ ] or other difficulties [ ]

2. Medical Conditions – Asthma [ ] Epilepsy [ ] Heart Conditions [ ] Diabetes [ ] Other ]

3. Allergies – Wasp Stings [ ] Food [ ] details_______________________________

Other allergies: [ ] details: _______________________________________________

4. Emotional Problems [ ] details_____________________________________________

5. Laterality - Right Handed [ ] Left Handed [ ] Mixed [ ]

6. Additional Information – Please give details and specify any condition not listed above which might be considered to affect the child’s ability to benefit from school. If there are any medical reports in relation to any of the above, could we please have a copy of same?

____________________________________________________________________________________________

____________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

7. Does your child require regular medication? Yes [ ] No [ ]

8. Does your child show any behavioural challenges? __________________________________________________________________________________

Did your child attend playschool and/or crèche? __________

Name of Playschool: _________________________________Dates:______________________

Name of Crèche ____________________________________Dates:________________________

Are there any issues you think the school may need to know about?

__________________________________________________________________________________

__________________________________________________________________________________

Does your child have any special educational, physical, emotional, language etc. needs?

__________________________________________________________________________________

__________________________________________________________________________________

12. Has your child ever been assessed for any reason? Yes No

13. If yes, are reports available? Yes No

13. Has there been any major trauma in your child’s life?

__________________________________________________________________________________

__________________________________________________________________________________

PLEASE ATTACH A COPY OF ALL ASSESSMENTS RELATING TO YOUR CHILD’S DEVELOPMENT AND/ OF NEEDS. IF ANY OF THE DETAILS IN THIS FORM CHANGE- E.G., IF YOU MOVE HOUSE, CHANGE YOUR PHONE NUMBER ETC. PLEASE INFORM THE SCHOOL IMMEDIATELY

Signed: _____________________ Dated: ________________________

Parent/Guardian

Signed: _____________________ Dated: ________________________

Parent/Guardian

English as an additional need

Child’s name: ___________________

Country of Origin: _________

Year of arrival of child in Ireland: _____________________

Other family members in Ireland ________________________________________

Has your child attended a playschool? Yes ( ) No ( )

In Ireland?	Yes ( ) No ( )

5. Has your child attended any other school in Ireland? ___________________________________

Education in own language:

6. Did your child attend school in country of origin? Yes ( ) No ( )

If yes, for how many years? ___________________

Language spoken at home: ______________

9. Does your child read in own language? Yes ( ) No ( )

10. Does your child write in own language? Yes ( ) No ( )

11. How well does your child speak/understand English? ____________________________________

12. Do you feel your child would benefit from extra English lessons? __________________________

13. Is there any further information you have that could help us with your child?

_____________________________________________________________________________

14. Any other information that may be relevant/appropriate?

_____________________________________________________________________________