Enrolment Form

Ainm an Pháiste/Name of Child (as on birth cert)

Date of birth

Uimhir PPS an pháiste/ Child's PPS number

Ainm na Máthar/Mothers Name

Mothers Mobile Number

Ainm an Athar/Fathers Name

Fathers Mobile Number

Your Email Address

Seoladh/Address

Address Line 2

Town

County

Your Eircode

Any Health Problems/Aon fhadhbanna Sláinte

Pupils Favourite Hobbies/Caitheamh Aimsire is maith leis an dálta

Ainm dochtúra/Doctor's Name:

Gaolta sa Scoil/ Relations who attend or attended Gaelscoil Lorgan (Tick all that apply)
MotherFatherSibling

Derabhaím go bhfuil an fógra iontrála agus an polasaí léite agam/ I confirm that I have read the Admissions Notice and the Admissions Policy
Dearbhaím / I Confirm