Bohola National School, Bohola, Claremorris, Co.Mayo
                              Roll Number:19914F
                   Application for Enrolment in September 2021.
The Department of Education and Skills has developed an electronic database of primary school pupils called the Primary Online Database (POD) which involves schools maintaining and returning data on pupils to the Department at individual pupil level on a live system. This information will be used to evaluate progress and outcomes of pupils at primary level, to validate school enrolment returns for grant payment and teacher allocation purposes, to follow up on pupils who do not make the transfer from primary to post primary level and for statistical reporting. The database will hold data on all primary school pupils. The database will also contain, on an optional basis, information on the pupil's religion and on their ethnic or cultural background. The data required for POD is marked with an asterisk * and will only be uploaded to POD if your child is enrolled. In order to assist with the gathering of data please complete the form in CAPITAL LETTERS and return to the school. This form will be retained by the school.
*Pupil’s First Name:__________________*Pupil’s Surname_______________ 
*Gender : Male ( ) Female ( )
*Birth Cert First Name: (if different from above) _____________________
*Birth Cert Surname: (if different from above) _______________________ 
*Nationality: ____________________ 
*Pupil Address:___________________________________________
*Pupil Date of Birth: ________________ 
*Pupil PPSN : _______________ 

Father’s Name: ___________________ Address __________________________
                                                                  (If different from pupil)
Mother’s Name: __________________ Address: __________________________
                                                                                          (If different from pupil) 

Mobile No. (father) ______________________Nationality__________________
Mobile No. (mother) _____________________ Nationality __________________ 

*Mother’s Maiden Surname: ____________________ 

*Is one of the pupil’s mother tongues (i.e. language spoken at home) Irish or English Yes/No
*Religion ___________________________

Do you consent to uploading data relating to religion to POD Yes /No 

Signed: _________________________

 * To which ethnic or cultural background group does your child belong? Please tick one 
White Irish [ ] Irish Traveller [ ] Roma [ ] Black African [ ] Any other White Background [ ] Any other Black Background [ ] Chinese [ ] Any other Asian background  [ ] Other (inc. mixed background) [ ]

 Do you consent to uploading data relating to ethnicity to POD Yes/No 
Signed: ___________________________
The following information is required for the efficient running of the school and will not be uploaded to POD
 
Email address: ____________________________________ 

Legal Guardian (if applicable): _________________________

Guardian’s Address (if applicable): 
_______________________________________________

Guardians Contact No. (if applicable): __________________

Emergency Contact No: ___________________________________ (Other than home/parents)
Nominated mobile number for Text-a-Parent: ________________________

Family Doctor: _____________________________
Phone no: ______________________ 

Does your child require school bus transport? ______________________ 

Does your child have any problem with speech, hearing or sight? If yes, please give more details: __________________________________________________________________________________________________________________________________
Any special needs/allergy/medical condition? _______________________________
Any physical disabilities? _________________________________________________________________ __________________________________________________________________________________________________________________________________
Has your child ever received support from Western Care or Child Psychological services? __________________________________________________________________________________________________________________________________ _________________________________________________________________

Previous schools attended (include playschool(s) and dates attended ) ___________________________ ______________________________

If transferring, give reason for transfer: _________________________________________________________________ _________________________________________________________________ 

Please add any other information you may feel is relevant. _________________________________________________________________ _________________________________________________________________ 
Please name the people who have permission to collect your child(ren) at 2.00pm ___________________________ ____________________________ ___________________________ ____________________________ 

**Please note that children will not be allowed to go home with someone who is not named above or who is not known to the school staff. (You may however contact the school if there is a change)

Parent /Guardian Signature: _____________________

Date: ______________________
Checklist
Please ensure that you have provided the school with the following:

o	Baptismal Certificate (copy) – not necessary if baptised in the Church of the Immaculate Conception and St. Joseph, Bohola

o	Birth Certificate (copy) 

o	Parent/Guardian Contact and Emergency contact details

o	Doctors contact details and any relevant medical information

o	If relevant - details of any special needs, disabilities, difficulties, psychological issues and reports

o	Parental/Guardian permission section filled out and signed

Parental/Guardian Permission 
Each year, we ask permission for your child to participate in certain activities. In order to cut down on unnecessary paperwork and simplify record-keeping, we have decided to include as many permissions as possible on one sheet. Please read carefully each of the items below and circle the relevant answer. Not all occasions may be relevant to your child this year, but they probably will be at some stage in the future. If you have any concerns regarding any of the items below please feel free to contact the class teacher or principal.
 I hereby give permission for my child in relation to the following: Circle YES or NO
 1. Go on school tours, educational visits, field trips and participate in school activities, (e.g. nature walks, church visits, museum visit, matches, quizzes, choir, etc.) YES/NO 
2. Have his/her photograph taken while engaging in school activities and events and used for a variety of purposes (eg, newpapers, school website, noticeboards, Bohola Post etc.) YES/NO 
3. To receive support at various times from all the teaching staff in the school, and on occasion to work with a teacher in a room which is not their regular classroom. (If your child is experiencing learning difficulty you will be informed personally by the class teacher.) YES/NO
 4. To be taken immediately to a doctor or hospital in the case of a serious illness/accident. YES/NO
 5. To complete Ability /Assessment tests (which will be administered from time to time). YES/NO 
6. To prepare and participate in Sacramental Programmes. YES/NO 
7. For my child’s uniform to be changed by an adult member of staff in the presence of another adult in the case of illness, toileting accident or a playground accident where their clothes are very wet/soiled YES/NO 
8. For relevant information to be shared with outside agency e.g. HSE who may require it for Medical/Dental reasons YES/NO

Parent /Guardian Signature: _________________________ 
Date: __________________