Scoil Oilibhéir Enrolment Form Should you have any questions when filling out the Enrolment Form, feel free to contact the school on 021-4309171 INFORMATION ON CHILD TO BE ENROLLEDClass/Year in which you wish to enrol your child Child's Personal DetailsSurname First Name Date of Birth Gender AddressPPSN Number Medical Card Number Religion Nationality First Language Place of Child in Family Siblings already in the school/classesPlayschool/ Previous School The following question is completely optional. If you do not consent to provide this information please tick the "No Consent" box. To which ethnic or cultural background group does your child belong? (please tick one) Select All White Irish Roma Black African Chinese Irish Traveller Any other White background Other Black background Any other Asian background Other (including mixed background) No Consent MEDICAL DETAILSIn order to begin the application process to have resources in place for September, we need to have the following information. If you wish to consult with us concerning information requested please do not hesitate to contact the school. Please include any information necessary for the health, safety and well being of your child at school. NOTE- No medication can be brought to school without prior arrangement with the Principal and the Board of ManagementChild's Doctor Phone Number Does your child suffer from any medical condition or allergy? Yes No Please select the relevant medical condition.DiabetesEpilepsyAsthmaAllergiesAny physical impairmentAny otherIf yes, please give detailsHas your child ever attended (or is he/she awaiting an appointment with ) any of the followingPsychologistHSE Social Work DepartmentSpeech TherapistOccupational TherapistPhysiotherapistOphthalmologistAudiologistIf yes to any of the above please give details and ensure reports are available to be forwarded to the school if necessary.If there is any issue about your child the school should be aware of, please provide details herePARENT/GUARDIAN INFORMATIONIf any legal order exists under Family Law that the school should be made aware of, please have a copy of said order available to be forwarded to the school if necessary. Please inform school of any changes of address or phone number.Mother's Name AddressPhone Number Occupation Email Address Mother's Maiden Name Father's Name AddressPhone Number Occupation Email Address EMERGENCY CONTACTSPupils who become ill while at school need to be cared for as soon as possible. This usually involves being taken home to a neighbour or relatives house if the parents are not contactable. It is vital for us to have access to a number of other contact persons for each pupils. Name 1 Phone Number AddressName 2 Phone Number AddressInformation supplied on this form will be treated with sensitivity and confidentiality.If you wish to consult with us please do not hesitate to do so. Child's Birth Cert must accompany this form. Δ