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:

Fathers Details:

Fathers Name:

Fathers Address:

Contact Number:

Occupation:

Nationality:

Email:

Alternative Emergency Contact Name & Number: (Grandparent/Relation/Friend)

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

If NO: Name of Pre-School/Childcare Setting attended

Has Applicant siblings currently attending St Audoen’s NS:
YesNo

(If yes) Name:

Has Applicant siblings who are Past Pupils of St Audoen’s NS
YesNo
(If yes)Name:

Has Applicant a Parent who was a past pupil of St Audoen’s NS
YesNo
(If yes)Name:

If leaving another primary school in the state, please state reason:

Medical & Developmental Information

Has your child attended speech therapy?
YesNo

Has your child attended an Educational Psychologist?
YesNo

Has your child ever attended an Occupational Therapist?
YesNo

Has your child ever attended CAMHS?
YesNo

If you have answered Yes to any of the previous medical questions please give the details here:

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? Please give details here.

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 note; withholding information regarding your child’s developmental or educational needs may affect your application. Please enclose any relevant reports or documents regarding the above.

Parental Declaration

Please tick the box to confirm you will comply with the school’s Fee Policy. This yearly fee includes books Book Rental (optional) & insurance, supplementary resources, IT equipment, photocopying and parent app access ‘Connect’. This fee must be paid before your child begins each new academic year. Any damage to school property will incur an extra fee.
Yes

Please tick the box to confirm you will comply with the school’s Code of Behaviour, including our school behaviour expectations and values which encourage and develop a strong sense of personal responsibility and respect.
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 will comply with the school’s Special Educational, Inclusion & Support Policy. The school aims to support each individual child to ensure that they receive support in order to access the curriculum and achieve their learning potential. For example; the school may recommend your child receive extra tuition in a small classroom setting with a support teacher for a specific subject.
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

Please note: 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, GDPR and Social Media & 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/CAMHS/Medical & Support Services, if applicable (All reports must be included with your application. Withholding of relevant information may result in admission refusal).

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.

Incomplete forms will not be processed and will not added to the list of applicants.

For further information please phone reception