The Junior School

NO MORE APPLICATIONS ARE ACCEPTED FOR PRE-RECEPTION 2011.

Please enter N/A to fields that are not applicable to you.

APPLICATION FOR ADMISSION OF PUPILS

1. Surname of child

2. Other Names

3. Date of Birth

DAY MONTH YEAR

4. Place of Birth

5. Nationality

6. Religion

7. Sex

MALE FEMALE

8. No. of children in the family & child's position

9. Does your child have a brother or a sister in
The Junior School or Senior School?

YES NO

Name & class(es)

10. Date you wish your child to join the school

11. Estimated length of stay at this school

12. Is it your intention to enroll your child in our Senior School once he/she has completed the Junior School?

YES NO

13. Language spoken at home

14. Present &/or previous schools

Name of School	Country	Dates from / to	Class

15. Father's Name

Mother's Name

16. Father's Nationality

Mother's Nationality

17. Father's Profession

Mother's Profession

18. Father's E-mail address

Mother's E-mail address

19. Father's Work address

Mother's Work address

20. Home address

21. Postal address

22. Parents are entitled to become members of the Junior School Company.
[please complete cards which will be provided by the School Secretary]

PUPIL'S MEDICAL INFORMATION

1. Emergency Contacts

Father's mobile

Mother's mobile

Father's home

Mother's home

Father's work

Mother's work

please name two people who have agreed to accept responsibility for your child if neither parent can be contacted

Name of 1st contact

Mobile

Home

Work

Name of 2nd contact

Mobile

Home

Work

2. Immunization and vaccinations (Please give most recent dates)

Diphtheria	Pneumococcus
Whooping Cough	Hepatitis
Tetanus	Measles
German Measles	Mumps
Haemophilis Influenzae	Heningococcus C
Polio	Vanicella

3. Please check DISEASES your child has had and give dates

Chicken Pox		Measles
Poliomyelitis		German Measles
Bronchitis		Tonsillitis
Mumps		Pleurisy
Diphtheria		Pneumonia
Hepatitis		Scarlet Fever
Rheumatic Fever		Whooping Cough
Other:

4.Does your child have any history of the following? [YES / NO]

Epilepsy YES NO	Heart Disease YES NO	Diabetes YES NO
Tuberculosis YES NO	Other

5. Is your child on medication? YES NO

If yes, please explain

6. Does your child have any allergy or drug sensitivity? YES NO

If yes, please explain

7. If your child has been seriously injured or had surgery, please explain below:

Operation / Injury: [please specify dates]

8. Does your child wear any of the following health aids?

Spectacles YES NO	Hearing Aid YES NO	Orthopaedic Aid YES NO
Other

9. Are there any medical restrictions imposed on your child's PHYSICAL ACTIVITIES?
YES NO

Please explain

10. Does your child require any special seating arrangements in class due to hearing or sight problems? YES NO

Please explain

11. Does your child have any behavioural problems? YES NO

If yes, please elaborate

12. Please give any significant information which you feel would be helpful to the school in order to meet and understand the physical and emotional needs of your child:

If you have answered 'yes' to number 11 you should submit any relevant documentation to the school, i.e. Psychologists' reports, information from your child's last school, medical reports, etc. All such documentation will be handled in the strictest confidence. Should it be discovered subsequently that vital facts have been withheld from our notice, this could result in the immediate withdrawal of your child from The Junior School.

RULES & REGULATIONS FOR ALL PARENTS

When applying for a place at The Junior School a �Registration Fee� of �150 is charged when the application form is submitted to the School. This amount is not refundable.
Prospective pupils will be assessed and interviewed on the school premises.
If a place is offered, parents should immediately pay a �750 �School Development Fee� in order to secure the place; this amount is not refundable.
Additionally, a deposit on the first term�s fees must be paid within two weeks of the place being offered. The deposit will be deducted from the fees, but otherwise is non-refundable. If the deposit is not paid, the place may no longer be held. Payments to the School should be made by cheque.
A full term�s notice, in writing, must be sent to the Headteacher before your child is due to leave the school. Failure to give the required amount of notice will result in tuition fees being charged for the following term.

DECLARATION
I have read the rules and regulations. If my child is offered a place I will accept the conditions set out above. DATE

ENCLOSURES
The following must be forwarded to the School by post:
a] A copy of birth certificate.
b] A copy of passport details.
c] A copy of last school report.
d] Two passport size photos.
e] Medical certificate.
f] € 150 Registration Fee