Surname

First names

School previously attended (give address, phone number and class)

The Board of Management considers applications in September for the following school year. Being aware of this, I/we wish to register an intention to apply for admission of the above applicant pupils to Whitechurch National School for ________________ (date)                                       

in accordance with the foregoing information.

I/We understand this registration places the applicant pupil on a list of those intending to apply for admission for the term and the date stated.

I/We understand that this registration does not offer any preferment to the applicant pupil and does not guarantee any place for him/her either for the term and year requested or for any other term or year.

I/We confirm that all the information entered on this form is fully correct to my/our knowledge.

Signature of mother/guardian: _____________________________ Date: _________________

Signature of father/guardian: ______________________________ Date: _________________

Surname

First names

School previously attended (give address, phone number and class)

Please have the following section completed by your clergyman, minister or pastor.

I certify that ________________________________________________(enter name(s) of parent(s)/guardian(s)

is/are members of the parish of __________________________________enter name of parish)

I certify that ___________________________________________(enter name of child listed overleaf)

has been baptised according to the practice of ________________________________________

(enter the Church of Ireland or the Presbyterian Church, or the Methodist Church, or the Roman Catholic Church or other denominational name)

Signed _____________________________ Name:____________________________________

                                                                        (in block capitals)

Position held: (e.g. rector, curate, pastor etc.) ________________________________________

Date: ____________________

Please enter any other relevant information here including details of any special physical or learning needs which your child may have.

I /We wish to apply to the Board of Management of Whitechurch National School to have my/our child enrolled in the school in ________________ (date)

I/We understand that the completion of this enrolment application form does not guarantee that a place in the school will be made available to my/our child.

I/We confirm that all the information entered on this form is fully correct to my/our knowledge.

Signature of mother/guardian: ____________________________    Date: __________

Signature of father/guardian: ____________________________                Date:___________