Fields marked with * are required

Student Personal

Which Year? *

Student Personal Details

Student's Surname *

Student's First Name *

Student's Address *

Student's Date of Birth *

Primary School *

Transport Form *

Tansport Form REQUIRED Transport Form NOT required

Does the applicant have a brother in the School? *

Yes No

Did the applicant have a brother in school previously? *

Yes No

Brother's Name

Adult Contact 1

Parents'/Guardians' Contact Details #1

Parent's Surname *

Parent's First Name *

Relationship *

Parent's Address *

Parent's Mobile Number *

Parent's Home Number *

Parent's Work Number *

Parent's Email *

Please be aware that primary correspondence from School to home is by email - it is essential that you print your email clearly.

Correspondence will be sent to one email and mobile only unless otherwise specified.

Verification of Contact Details *

This is the Main Contact This is NOT the main contact.

Please inform the school if any of the contact details change

Adult Contact 2

Parents'/Guardians' Contact Details #2

Parent's Surname

Parent's First Name

Relationship

Parent's Address

Parent's Home Number

Parent's Mobile Number

Parent's Work Number

Parent's Email

Please be aware that primary correspondence from School to home is by email - it is essential that you print your email clearly.

Correspondence will be sent to one email and mobile only unless otherwise specified.

Verification of Contact Details

This is the Main Contact This is NOT the main contact.

Please inform the school if any of the contact details change

Notes and Other Info

Notes

Any other relevant information you wish to provide?

Code of Behaviour Agreement *

We have read and agree to abide by the Code of Behaviour and other school policies. We understand that enrolment is based on this agreement.

CBS Ennistymon is a data controller and collects personal student data for the purpose of student identi ca- tion, enrolment and communication with parents / guardians. CBS Ennistymon is required to return this data, in the October Returns, to the Department of Education and Skills to avail of the funding and services provided by the Department. CBS Ennistymon undertakes to comply with the requirements of the Data Protection Act and to ensure that this data is kept securely and only used for the purpose stated.

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Principal: Mrs Mary Lyons

Deputy Principal: Mr Michael Clohessy

Monastary Lane Ennistymon County Clare V95 W880 Ireland

office@cbsennistymon.com

+353 (0)65 707 1349

+353 (0)65 707 2005

http://cbsennistymon.com

Student Enrolment Form