Sloinneadh An Pháiste (Surname of Child) ___________________
Ainmneacha Baiste (Christian Name) __________________
Seoladh (Address)_______________________________________________________________
Dáta Bréithe (Date of Birth)______________
Dáta Tosaithe (Date Starting School) September 20__
Uimhir Teileafón (Telephone Number) __________________
Uimhir Oibre (Work Number) ________________
Slí Bheatha An Athar (Father's Occupation)_________________________________________________________
Slí Bheatha Na Máthar (Mother's Occupation)__________________________________________________
Ar Fhréastal an páiste ar aon Reamhscoil (Did the Child attend any Pre School? )_________________
Ar Fhréastal an Páiste ar aon scoil eile roimhe seo (Did the Child attend any other school previously)______________
Aon fhadhb phearsanta no tinneas ba choir, armhaithe leasa an pháiste, a bheith ar eolas ag Príomh Oide na Scoile
Any personal difficulties or illness which, for the childs own benifit should be known to the Principal of the Gaelscoil _________________________________________________________________________________________________________
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Táim sásta le h aidhmeanna Gaeilge agus Oideachasúla na scoile agus, da réir, déanfaidh mé gach dícheall tacú le mo pháiste, sa bhaile, na haidhmeanna sin a bhaint amach. I am satisfied with the Irish language and educational aims of the school and accordingly, I will make every effort to support my child, at home, to achieve those aims.
Siniú: Tuiste/Caomhnoir (Parent/Guardian.) _________________________________
Data (Date) _______________