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St. Patrick’s Preschools & Afterschool Care Service,
Gardiners Hill,
Cork.
stpatrickspreschool@yahoo.ie lt Tel: 087-
APPLICATION FORM
If you wish to apply for a place for your son/daughter in St. Patrick’s Preschool Classes, this application form should be filled in and returned via email to stpatrickspreschool@yahoo.ie
Or post to St. Patrick’s Preschool & Afterschool Care Service, Gardiners Hill, Cork. T23VAD9
Your application will be processed but it does not guarantee your son/daughter a place. Their names will be put on a waiting list if no place is available. You will be informed of the status of your application.
Child’s Full Name: ______________________ Date of Birth: _______________
Child’s PPSN: __________________________
Home Address: ___________________________________________________________________________________________________________________________________________________________________________________________________
Home Telephone Number: _________________Sex: Male/Female___________
Email Address: __________________________Intended Primary School: _________________________________________________________________
Parent/Guardian
Name: ________________________ Name: __________________________
Work Place Address: _____________ Work Place Address: _______________
_______________________________ _____________________________
_______________________________ ______________________________
_______________________________ _______________________________
Contact Number: _________________ Contact Number: _________________
Who does the child live with: ________________________________________
Sibling information:
Name: __________________________
Age: ___________________________
Preschool: ______________________
School: _________________________
Name: __________________________
Age: ___________________________
Preschool: ______________________
School: _________________________
Name: __________________________
Age: ___________________________
Preschool: ______________________
School: _________________________
Designated people to collect child (other than parents/guardians):
Name: _________________________________
Address: ________________________________________________________
Tel: ___________________________________
Name: _________________________________
Address: ________________________________________________________
Tel: ___________________________________
Name: _________________________________
Address: ________________________________________________________
Tel: ___________________________________
Name: _________________________________
Address: ________________________________________________________
Tel: ___________________________________
Family Doctor: __________________________
Address: ___________________________________________________________________________________________________________________________________________________________________________________________________
Contact number _________________________
Please attach a copy of child’s vaccination passport
Does your child suffer from any medical conditions/allergies? ____________________________________________________________________________________________________________________________________________________________________________________________ ________ ________________________________________________________________
Does your child have any hearing or speech difficulties?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Does your child have any dietary conditions or special dietary requirements?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Additional information that you feel you may need to know.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Is your child availing of any services such as Early Intervention or awaiting assessments?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
To complete your registration please attach the follow items:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Copy of child’s Vaccination Passport
Copy of Birth Certificate
Preferred session time if available:
Morning
Afternoon