St. Sourney's N.S., Ballinderreen, Kilcolgan, Co. Galway.
Tel./Fax 091-796632 Email:firstname.lastname@example.org
Before completing this form please visit the Policy Section of the website to review the following school policies:Please complete all sections of this form and return it to the school.
Section 1: General Information
Surname: ________________ First Name(s): _____________________
Irish version of childís name: ___________________________________
Date of birth: ________________ Home Tel. No: ___________________
Religion: ___________________ Date of Baptism: __________________
Place of Baptism: ____________________________________________
Fatherís Name: _________________ Occupation: ___________________
Work Tel. No.:__________________ Mobile: _____________________
Motherís Name: _________________ Occupation: ___________________
Work Tel No.___________________ Mobile: _____________________
Previous School (if any) ____________________Report Included : Yes/No
Child's P.P.S. Number: _________________________________________
In case of:
- emergency closing of school
- of your child being sick or
- having an accident during school times, please indicate:
Name of Person to be contacted:_______________________________
Any other relevant information: (illness, allergies, difficulties, talents etc.) This information may help the teacher understand your child and will be held in confidence.
In case of an emergency, a member of the school staff will take your child to an available doctor.
I have read the school policies (located in the school policies section of the website) and I agree to abide by them.
Parentís / Guardians Signature: _________________________________
- School report, psychological assessment, language therapistís report, with application form, if applicable.
- Birth certificate (for competition entries).
- Baptismal Certificate, if baptised outside parish (for Confirmation).
Originals will be returned when photocopied.
Section 2: Social, Personal & Health Education
We are teaching a subject called Social, Personal & Health Education (S.P.H.E.). This subject incorporates the Stay Safe Programme, Relationships and Sexuality Education (RSE) Programme, Health Education Programme and The Walk Tall Program (A Substance Abuse Prevention Programme).
The teachers have attended inservice on these programmes and have taught the S.P.H.E. curriculum already.
You may be asked to participate in you childís learning as we work through the various activities in the programme or you may wish to discuss the various topics with your child from time to time. Your positive participation will help in fostering the successful teaching of the subject.
Copies of the resource materials being used are available in the school for viewing if you wish. If you have any questions, please feel free to discuss these with your childís teacher.
Please sign the consent form below and return it to the school
St. Sourney's N.S. Ė S.P.H.E. CONSENT FORM
I want my child ___________________ to take part in the R.S.E. and the Stay Safe modules of the S.P.H.E. programme being taught in Ballinderreen National School
I do not want my child _________________to take part in the R.S.E. and the Stay Safe modules of the S.P.H.E. programme being taught in Ballinderreen N.S.
Parent/Guardianís Signature: ____________________________________
Section 3: Learning Support TeachingWe are delighted to be able to offer support to children who may need extra help during the school year. This will include early intervention in the Lower Classes. It is envisaged that the Learning Support Teacher will take out small groups of children or whole classes and work with them in the area of phonics, pre-reading and writing skills. Please indicate your permission below for this process to occur.
I permit my child _______________________________ to be assisted by the Learning Support Teacher as necessary while attending St. Sourney's N.S.
I do not permit my child__ _________________________to attend the Learning Support Teacher while attending St. Sourney's N.S.
Parent/Guardian's Signature ___________________________________
Section 4 Information & Communication Technology Acceptable Use Policy (AUP)
To read the Internet Acceptable Use Policy please click here
Please review the Internet Acceptable Use Policy, sign and return this permission form to the Principal.
School Name: St. Sourney's N.S., Ballinderreen
Name of Pupil: _____________________________________________
I agree to follow the schoolís Acceptable Use Policy on the use of the Internet. I will use the Internet in a responsible way and obey all the rules explained to me by the school.
Pupilís Signature: ____________________ Date: ___________________
As the parent or legal guardian of the above pupil, I have read the Acceptable Use Policy and grant permission for my son/daughter or the child in my care to access the Internet. I understand that Internet access is intended for educational purposes. I also understand that every reasonable precaution has been taken by the school to provide for online safety but the school cannot be held responsible if pupils access unsuitable websites.
I accept the above paragraph □ I do not accept the above paragraph □
(Please tick as appropriate)
St. Sourney's N.S., Ballinderreen is currently developing a school website. We hope to include group and individual photographs of pupils engaged in educational activities throughout this website. Pupils will be identified by first name and class only. Under no circumstances will the child's surname or any other personal details be included. Please indicate your permission for this process to occur by signing the form and returning it to the Principal. ________________________________________________________________________
I permit digital photographs of my child ___________________________ to be published on the school website in an educational context.
I do not permit digital photographs of my child______________________ to be published on the school website in an educational context.
Signature of Parent/Guardian____________________________________