Personal Information

Name of Child as on Birth Certificate:

Sex of child:
MaleFemale

Pronunciation:

Date of Birth:

PPS Number:

Year to be Enrolled:

Class applying for:
JISI1st2nd3rd4th5th6thASD Class

Child's Address:

Nationality:

Country of Birth:

Religion:

Do you wish your child to attend & participate in school Religious Services/Mass:
YesNo

Special Religious Notes (dietary/participation):

Parents Details

Mothers Details

Mothers Name:

Mothers Address:

Contact Number:

Occupation:

Nationality:

Email:

Alternative Emergency Contact Name & Number: (Aunt/Uncle/Family Friend)

Fathers Details:

Fathers Name:

Fathers Address:

Contact Number:

Occupation:

Nationality:

Email:

Alternative Emergency Contact Name & Number: (Aunt/Uncle/Family Friend)

Parents Relationship:
MarriedLiving TogetherSeparatedDivorcedOther

Parents attended St. Audoen's National School?
YesNo

Name:
Relationship to child:
Age:

Has your child attended St Audoen's Pre-School?
YesNo

If moving from another School or Pre-School:

Name of previous school/pre-school:

Reason for leaving (school):

Medical & Developmental Information

Has your child attended speech therapy?
YesNo

If yes, please give further details:

Has your child attended an Educational Psychologist?
YesNo

If yes, please give further details:

Has your child ever attended an Occupational Therapist?
YesNo

If yes, please give further details:

Has your child ever attended CAMHS?
YesNo

If yes, please give further details:

Are there any other details regarding your child’s development that you feel the school should be made aware of?

MEDICAL QUESTIONNAIRE

This information will be held in the strictest of confidence.

Has your child had any of the following?

Asthma
YesNo

Heart Condition
YesNo

Fits, fainting or blackouts
YesNo

Epilepsy
YesNo

Diabetes
YesNo

Blood Disorder
YesNo

Allergies to any known drugs or medication
YesNo

Other Allergies (Materials/Creams/Insects)
YesNo

Does your child use any medication including inhalers, injections, creams, tablets, liquids...?
YesNo

If the answer to any of the questions above is YES please give details here.

Does your child have any illness/condition that he/she is currently being treated for?

Medication/Medical Treatment/ Dosage:

Sight

Does he/she have a known visual problem?
YesNo

Does he/she wear glasses?
YesNo

Hearing

Does he/she have intermittent ear problems?
YesNo

Dietary

Please let us know of any dietary restrictions/food allergies your child may have:

Please keep the school updated on your child’s medical details.

Parental Declaration

Please tick the box to confirm you will comply with the school’s Book Rental Policy. This yearly fee includes all copybooks, work books and text books your child will need throughout the year. This fee must be paid before your child begins each new academic year. Any damage to school property will incur a fee.
Yes

Please tick the box to confirm you will comply with the school’s Code of Behaviour, including our school rules and values which encourage and develop a strong sense of personal responsibility and responsibility towards others in our school.
Yes

Please tick the box to confirm you will comply with the school’s Uniform Policy. Children must wear the official crested school uniform (jumper, tie & tracksuit) which is available from John Lawrence Clothing on Thomas Street.
Yes

Please tick the box to confirm you will comply with the school’s Presentation Policy (Dress Code & Regulations). Children are expected to be neat, tidy and well groomed. Dyed hair is not allowed. Excessive wearing of earrings, chains, bracelets and facial jewellery may not be worn in school or at any public school occasion.
Yes

Please tick the box to confirm you are happy for your child to engage in our Story Massage Programme. Story Massage combines the benefits of positive touch with the creativity of storytelling. It is a fun and therapeutic activity; done on the upper parts of the body, such as the neck, shoulders and back, while the child is in a seated position and fully clothed. It is gentle, respectful and encourages positive touch in school, home or wider community.
Yes

Your child may be photographed and/or pictured on the school’s website and publications occasionally. Please note this is done strictly in line with our Child Protection Policy and Social Media and Website Use Policy.

Please send any the following relevant reports and/or information you have regarding your child’s needs to info@staudoens.ie :

Please ensure you have included the following with your application:

1. Fully completed application form
2. Copy of Birth Certificate
3. Reports from previous school (if applicable)
4. Reports from relevant HSE/Medical services, if applicable.

Please note:

Junior Infant Applications will be accepted any number of years in advance of desired admission date but early application does not guarantee admission. Priority criteria will be applied.

Applications for Classes for SI - 6th will be held for a maximum of two years, thereafter, if a place has not become available, parents/guardians must re-apply or notify the school in writing of their wish to continue with said application.

For further information please phone reception