Enrolment Form

GUSSERANE NATIONAL SCHOOL                   Scoil Náisiúnta Ráth na gCosarán

Gusserane, New Ross,                                        Ráth na gCosarán, Ros Mhic Treoin,

Co. Wexford.                                                        Co.Loch Garman.

Y34 HV08                                                             Y34 HV08

Phone: 051 562107                                              Teileafón: 051 562107

Email: gusseranens@gmail.com                          Ríomhphost: gusseranens@gmail.com

Website: www.gusseranens.ie                              Láithreán gréasáin: www.gusseranens.ie


Childs Personal Details

Students Name: __________________________________________________________________

Students Date of Birth: ______________________________        Gender: ____________________

                               (Please attach a copy of the child’s Birth Cert)

Students Address: ________________________________________________________________

Nationality of Child: _________________________             PPS Number: ______________________

Religion: _______________________           To be placed into: __________________________ class

If other members of the family already attend Gusserane National School please State:

Name: ______________________________________       Class: ____________________________

Name: ______________________________________       Class: ____________________________

Contact Details

Pupils sometimes take ill at school and need to be collected. On such occasions we will make contact with people on the contact list, in the order that has been given to the school.  However, it may be necessary to have the telephone number of your child’s Doctor.

Contact No. 1: ______________________     Name: _____________________________________

Contact No. 2: ______________________    Name: _____________________________________

Contact No. 3: ______________________    Name: _____________________________________

Contact No. 4: ______________________    Name: _____________________________________

Your child’s Doctor: ____________________________   TEL: ____________________________

Designated Mobile Number for Text-A-Parent: __________________________________________

E-Mail Addresses ___________________________________________________________ if you wish to receive school newsletter by email (this is a green school initiative).


In the event of an emergency, where neither parent/guardian can be contacted, do the teachers have your permission to undertake whatever action they deem necessary to safeguard your child’s health?

                                                Yes (     )      No (    )

If no, please indicate what action you would like us to take. ___________________________________



Medical Details




Any issues relating to custody of the child, guardianship, barring orders, legal documentation must be supplied in conjunction with this application of enrolment.




______________________________________        _____________________________________

Mother/Guardian                                                            Father/Guardian


Primary Online Database

Is one of the pupil’s mother tongues (ie language spoken at home) Irish Or English?  Yes       No

To which ethnic or cultural background group does your child belong? (please underline)

White Irish       Irish Traveller      Roma      Any other White Background

Black or Black Irish – African       Black or Black Irish – Any other Black Background

Asian or Asian Irish –Chinese        Asian or Asian Irish – Any other Asian Background

Other (inc. Mixed Background)       No Consent



Payment Contract

Pupils Name: __________________________________      Class: ____________________________

I understand that there will be certain cost relating to my child’s education in Gusserane National School.  These costs will be mainly in the area of book rental, education equipment/materials, PE, Drama and Text.  I agree to pay these costs.


Signed: _______________________________________      Date: __________________________

Previous School/Pre-School

School Name: _____________________________________________________________________

School Address: ___________________________________________________________________

Dates Attend: __________________________        Class in which enrolled: ______________________

Principal’s Name: _______________________________    Phone No.: _________________________

E-mail Address: ___________________________________________________________________



Mothers Name: ___________________________  Fathers Name: ___________________________

Address: ________________________________    Address: ______________________________

            (if different from pupils)                                  (if different from pupils)

Mothers Maiden Name: ______________________________

Names of any other Legal Guardians: ___________________________________________________

                                            (Please supply documentation)

If any of the details above change in any way (eg phone numbers, allergies etc) please let us know immediately


Premission Form

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 tick the relevant box.  Not all occasions may be relevant to your child.  If you have any concerns regarding any of the items below please feel free to contact the class teacher or principal.


Childs Name:  ______________________________________                   


I hereby give permission for my child in relation to the following:



Going on school tours, local educational visits/field trips and participating in school activities (e.g. Matches, quizzes, choir etc).



On occasions such as Communion, Confirmation and other school events (sports day, fun-run), local press photographers take group photos of children and in some instances identify the children by name.  Do you agree to the school using your child’s image in this way? (please remember that removing a child from a photo of the rest of the class can be quite upsetting for the child).



Can we use you child’s name (not photo) in relation to publicising school events and activities in our newsletter and similar publications?



As the parent/legal guardian of the above pupil, I grant permission for my son/daughter to access the internet.  I understand that internet access is designed for educational purposes.  I also understand that the school cannot be held responsible if pupils access unsuitable websites, but that every reasonable precaution has been taken by the school to provide for online safety.



I agree that, my child’s work may be published on the school Web site.  I also agree that photographs that include my child may be published subject to the school rules that photographs will not clearly identify individuals and that names will not be used.



Most schools have an extra support teacher assigned to help all children in the school.  On occasion, it may be necessary for organisational reasons to remove a group of children to another room to work with this teacher or the class teacher.  (If your child is experiencing learning difficulties you will be informed personally by the teacher.) Do you agree?



The school teaches “Stay Safe” lessons on personal safety and RSE lessons on developing and changing.   Both are recommended and vetted by the Dept. of Education and Skills.  Further information is available from the school.  Can your child participate in these lessons?



On occasion we administer “diagnostic” tests (e.g. micra-T, sigma-T) to discover the educational progress of pupils.  Should any concerns arise following these tests we will contact you.  Do you agree to this?



Your child’s uniform being changed by an adult member of staff in the presence of another adult in case of illness or toilet accident.



Do you give permission for your child to be taken immediately to a doctor or hospital in case of serious illness/accident?




Parents Signature: ____________________________________          Date: ___

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