Online Enrolment Acceptance Form

Please complete the form below after you have received an Enrolment offer from the School Principal.

All data collected through the following application form are processed in accordance with our Website Privacy Notice.

Enrolment Acceptance Form

Student's Forename

Surname

ENROLMENT FOR SCHOOL YEAR:

ENROLMENT FOR:

Please confirm your child's enrolment acceptance

I wish to accept the place being offered to my daughter/son

According to Section 10 of our Admission Policy we request the following information:

Please list the other school(s) offering you admission:

School Name(s) & Address(es)

Please list the other school(s) you are awaiting confirmation of an offer from:

School Name(s) & Address(es)

STUDENT DETAILS

Student's Date of Birth

DD/MM/YYYY

Student's PPS No.

The inclusion of the PPS number is essential in processing a student’s enrolment

Gender

Female

Male

Nationality

NATIONALITY is the preferred nationality which the parent/guardian (or student, where of an age deemed competent to do), so provides. It is chosen regardless of whether the student is adopted or has dual nationality.

Mother's Birth Name

Student's Address 1

Address 2

Address 3

Address 4

County

Eircode

Religion

Family Doctor

Family Doctor's Telephone No.

Medical Card

PARENTS'/GUARDIANS' CONTACT DETAILS:

Mother/ Guardian 1

First Name

Last Name

Address 1 (If different from Student's address)

Address 2

Address 3

Address 4

County

Eircode

Telephone Number

Email Address

Relationship to Student

Father / Guardian 2

First Name

Last Name

Address 1 (If different from Student's address)

Address 2

Address 3

Address 4

County

Eircode

Telephone Number

Email Address

Relationship to Student

Main Telephone Number to Contact

Main Email Address to Contact

Social Care/Foster Care

Please give details of any court orders or any other arrangements governing access to, or custody of the student

OTHER NAME & CONTACT

Other name & contact number in the event of parent/guardian not being available in case of sickness or an emergency

Other Contact - Name

First Name

Last Name

Telephone Number

Relationship to Student

Please confirm

I understand that it is my responsibility to inform the school of any change of address, telephone number(s), email address(s) or other relevant circumstances.

CURRENT SIBLINGS:

If the student currently has any siblings in this school, please indicate their name(s) and current year(s) of study.

Sibling's Name & Current Year

SCHOOL CURRENTLY ATTENDED BY STUDENT:

Currently Attended School Name

School Address

ADDITIONAL INFORMATION

Any medical condition?

Name of medical condition

Any Medications required for administration at school (e.g. Buccal Midazolam, inhaler):

SPECIAL EDUCATIONAL NEEDS:

It is the responsibility of the parent/guardian to give copies of any Reports to the post primary school.

In the current school has your child access to Learning Support?

Name of special education need (e.g. Dyslexia, ASD, Physical disability):

Is there any Assessment available (OT, Speech & Language, Psychological assessment, other)?

If Yes, please send a copy of the Assessment to the School.

Does your child have an Exemption from studying Irish?

If Yes, please send a copy of Department of Education & Skills Exemption Certificate to the School.

Date this exemption was granted

Please confirm

We / I give our / my consent to teachers from Mercy Secondary School Ballymahon to collect information, both written and verbal from my child's current school.

DEPARTMENT OF EDUCATION AND SKILLS DATA REQUEST FORM FOR THE COLLECTION AND RETURN OF STUDENT DATA BY THE SCHOOL TO THE DEPARTMENT OF EDUCATION AND SKILLS.

REF: CIRCULAR 0023/2016

Is English or Irish the MOTHER TONGUE of the student?

MOTHER TONGUE is the language a child speaks as their first language.

To which ethnic or cultural background does the above-named student belong? Please circle only one category (these categories used are based on the Census)

IN RESPECT OF THIS QUESTION YOU MAY OPT NOT TO PROVIDE AN ANSWER.

This form should be retained by the school for the duration of the student’s enrolment and made available for inspection by an officer of the Department or the Office of the Data Protection Commissioner, if required.

PHOTOGRAPHS OF STUDENTS:

Our school maintains a database of photographs from school events held over the years. It has become customary to take photos of students engaged in activities and events in the interest of creating a pictorial as well as historical record of life at the school. Photographs of student’s and in some cases including their name, may be published on our school website, app, on social media or in brochures, yearbooks, newsletters, local and national newspapers and similar school-related productions. Consent is requested from each parent / guardian / student over 18. Should the parent / guardian / student over 18 wish to have his/her/their child’s photograph removed from the school website, brochure, yearbooks, newsletters etc. at any time, we will duly comply on receipt of a written request to the school principal. Please note that any images/videos published by the school in yearbooks, newsletters, papers etc. up to this date, will remain in place based on previous consent given. No further images/videos will be published after the date of revocation.

Consent (tick one of the following 3 options):

1. If you are happy to have your child’s photograph taken as part of school activities and included in all such records, tick here

2. If you would prefer not to have your child’s photograph taken and included in such records, please tick here

3. If you are happy for your child’s photograph to be taken and included, as 1. above, but would prefer not to have images of your child appear on the school website, in school brochures, yearbooks, newsletters etc., please tick here

YOUR DETAILS:

Signed (Your Name)

First Name

Last Name

Your Email

PLEASE POST OR EMAIL TO SCHOOL FOLLOWING DOCUMENTS:

1. Copy of State Birth Certificate (this will not be returned).

2. Copy of Educational Psychological assessment (if applicable)

3. Copy of Department of Education & Skills Exemption Certificate (if applicable).

Alternatively, please download, fill and send the form to school:

DOWNLOAD PDF VERSION OF ENROLMENT ACCEPTANCE FORM