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Student Information
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Surname
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Name
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Address
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PPS Number
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Date of Birth
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DD
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YYYY
Fathers Name
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Fathers Occupation
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Mother Name
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Mothers Occupation
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Mothers Maiden Name
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Fathers Phone Number
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Mothers Phone Number
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Family Email Address
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Family Doctor
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Medical Card
Medical Conditions
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Other name in the event of parent/guardian not available in case of emergency
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Number in the event of parent/guardian not available in case of emergency
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Primary School Attended
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Nationality
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Religion
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We/I give consent to teachers from St. Mel's College Longford to collect information both written and verbal and receive copies of any professional reports concerning my child's education and development provided by the primary school. Please Sign
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If you do not wish your child's photography to be used on second publication. e.g. School Website
Does your child avail of learning support at Primary School
Has your child had a Psychological Assessment
Core Subjects. Please preferences which one your child would like to do
Irish Exemption
Reason for exemption
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Technology Subjects. Please preferences which one your child would like to do
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