Foirm Chláraithe / Registration Form – An Mhodhscoil

The Model Primary School, O'Connell Avenue Limerick, V94 W891, Ireland

Phone 061 315827 Email info@modelschool.ie

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Foirm Chláraithe / Registration Form

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Sonraí an Dalta (Student Details)

Anim an Dalta /Pupil's name: *
Dáta Breithe: (Date of Birth) *
PPS No: *
Creideamh / Religion: *

Eolas Teagmhála (Contact Details)

Seoladh / Address: *
Uimhir Ghutháin / Telephone No: *
Guthán Gluaiste / Mobile No: *

Sonraí na dTuismitheoirí / Parents Details:

Ainm an t-athair / Father's name: *
Slí Beatha / Occupation: *
Ainm an mháthair: (Mother's name) *
Slí Beatha / Occupation: *

Oideachas Roimhe Seo / Previous Education:

Ar Scoil Cheana / Previous Schools: *
Dátaí /Dates: *

Sláinte / Health:

Bhfuil aon chogas leighis á ghlacdh aige/aici faoi lathair / On Medication? *
(Describe any speech, sight or hearing problems, behaviour or learning difficulties). Is your child under medical supervision?

Eolas Eile /Other Info:

Aon Eolas ábharthach eile / Any other relevant information:
An bhfuil deartháir nó deifiúr an linbh ag freastal ar an scoil i láthair na huaire? / Does this child have any brother or sister attending this school at present?
Tá / YesNíl / No
Ainm an dalta / Pupil's name:
Rang (class)

Síniú Sínithe / Signature:

Síniú Sínithe / Signature: *
Date

Verification

Please enter any two digits *Example: 12
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