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):
Mothers Name:
Mothers Address:
Contact Number:
Occupation:
Email:
Fathers Name:
Fathers Address:
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:
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?
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:
Does he/she have a known visual problem? YesNo
Does he/she wear glasses? YesNo
Does he/she have intermittent ear problems? YesNo
Please let us know of any dietary restrictions/food allergies your child may have:
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 send any the following relevant reports and/or information you have regarding your child’s needs to info@staudoens.ie:
Fully completed application form
Copy of Birth Certificate
Reports from previous school (if applicable)
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).
