Scoil Naomh Anna

Principal: Jim Halligan
www.scoilnaomhanna.org email: stannes@ireland.com


ENROLLMENT FORM

Class ___________________________________________ Entry Year 20___________

Child’s PPS No. _________________________________ No. of Children in Family _______place in family ________

Surname _______________________________________ No. of Siblings attending St. Anne’s N.S.________________

First Names_____________________________________ Names of Siblings ____________________________________

Full Address ____________________________________ _____________________________________________________

____________________________________ Phone Nos. Home __________________________________

____________________________________ Work 1 __________________________________

Date of Birth ___________________________________ Work 2 __________________________________

Male/Female ___________________________________ 1st Mobile _________________________________

Father/Guardian _______________________________ 2nd Mobile ________________________________

Occupation ____________________________________ e-mail _______________________________________________

Mother/Guardian ______________________________ Other contact ________________________________________

Occupation ____________________________________ Emergency No. _______________________________________

Was the child baptised _________________________ Doctor’s Name _______________________________________

If so, date baptised _____________________________ Doctor’s Address ______________________________________

Where was the child baptised ___________________ Doctor’s Phone No. ___________________________________

Do you give permission to take your child straight to hospital in case of serious illness or accident?___________________

Does any legal order under family law exist that the school should know about? ___________________________________

Has the child had previous education ____________ Montessori? _________________Pre-school________________

Primary? _________Where?_____________________________

Parents Signature_______________________________ Date of Application____________________________________




Please complete the enclosed medical history form also.




Telephone: 01 2825565 Chairperson of BOM: Fr. John O’Connor
Fax: 01 2825565 Principal: Mr. Jim Halligan
e-mail: stannes@ireland.com Deputy Principal: Ms. Ellen Slattery
Roll No: 19888H



MEDICAL HISTORY St. Anne’s N.S.

Strictly Confidential
Please fill in the following form as soon as possible in order to help us address your child’s needs. This information will not affect your child’s entry to the school.

Child’s Name:___________________ Address: ________________________

PPS No: ______________________ e-mail :__________________________

Date of Birth:_____________________ Phone: ________________________

No. of children in Family ___________ Place in Family __________________

Birth History: ___________________________________________________

Childhood Illness: _______________________________________________

Developmental Milestones
Please list the approximate ages when your child:-

Walked?_________Crawled?_____________Talked?___________________

Have you any concerns relating to your child under the following headings? -
Yes/No
Eyesight, ______

Hearing, ______

Language/speech______

Behaviour, ______

Co-ordination ______

Has your child got any diagnosed medical condition? ______

If so please list same ____________________________________________

Does your child get on with his/her peers? ______
Does your child relate well to adults? ______
Is your child interested in Books? ______
What interests does your child have?________________________________

Has your child been referred to any outside agencies resulting in any of the following?:-

Psychological Report, ______
Speech and Language Report, ______
Occupational Therapy Report, ______
Please furnish the office with copies of any available reports a.s.a.p.

Any other comments of significance ________________________________________________________________________________

________________________________________________________________________________

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