Coláiste Phobal Chléire - Foirm Iarratais - Summercollege Application Form 2012
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Eolas ar chúrsaí - Course Information
Coláiste Phobal Chléire,
Oileán Chléire,
An Sciobairín,
Co. Chorcaí;

Guthán 028 39119;
R-phost: eolas@colaistephobalchleire.ie


Líon isteach gach cuid den bhfoirm seo, le do thoil.
Please fill in each part of this form.

TÁILLÍ - FEES:

Cúrsa A, B, C: €870

Cúrsa C1: €910

Ní mór éalais €400 a íoc roimh 1ú Aibreán 2012


Cén cúrsa ba mhaith leat - Which course would you like to book *
Cúrsaí do pháistí scoile 12-18 mbliana d'aois - Courses for schoolchildren 12-18 years of age
Ainm - Name *
Sloinne - Surname *
Seoladh - Address *
R-phost / e-mail *
Dáta breithe - Date of birth *
Scoil - School *
Bliain / Rang - Year / Class *
An rabhais i gColáiste Samhraidh roimis seo? Cathain agus cén ceann? - Did you attend a Summer College before? When and which one? *
Ní mór do scoláirí fanacht ar feadh thréimhse iomlán an chúrsa - Pupils are required to stay for the whole duration of the course *
Required
Scoláirí a chur abhaile - Students being sent home
Má sháraítear na rialacha thíos cuirfear daltaí abhaile láithreach. Ní féidir aon táillí a aisíoc sna cásanna sin. - Breaking of the rules below will result in immediate dismissal from the course. No refund of fees is payable in such a case.
* Alcól agus drugaí a thógáilt - taking alcohol or drugs
*má chuireann scoláire a bheatha féin nó beatha duine eile i mbaol
*drochiompar leanúnach, briseadh riail na Gaeilge san áireamh - continuous misbehaviour, including breaking of Irish language rule
* éalú ón tigh lóistín idir 10.30i.n. agus 9.30r.n. - Running away from the house between 10.30pm and 9.30am.

Tugaim cead snámha do mo pháiste - I allow my child to go swimming *
Ba chóir a bheith ar chumas do pháiste achar 25 méadar a shnámh gan chabhair - Your child should be able to swim a distance of 25 metres unaided
Required
An bhfuil sé ar intinn agat taisteal ar an mbus - Do you intend to travel on the bus? *
Fágfaidh bus speisialta Stáisiún traenach Kent i gCorcaigh ag tús gach cúrsa agus fillfidh bus ó Dhún na Séad i ndeireadh gach cursa. - A special bus for the college will leave Kent railway station in Cork at the beginning of each course and return from Baltimore at the end of each course
Required
Nóta: Freagracht i leith damáiste - Note: Responsibility for damage to property
Ní ghlacann an Coláiste nó Mná/Fir an tí le haon dliteanas i leith
caillteanais nó damáiste as trealamh an scoláire. - Coláiste
Phobal Chléire or host families accept no responsibility for loss
of or damage to the property of any student.

FOIRM SLÁINTE - HEALTH FORM
Ainm an scoláire - Name of pupil *
Inscne - Gender *
Required
An mbeidh tú as baile i gcaitheamh an chúrsa - will you be away from home during the course *
Required
Sonraí teagmhála éigeandála - Emergency contact details *
Tabhair ainm agus seoladh an duine ag a bhfuil údarás gníomhú thar do cheann muna féidir linn teagmháil a dhéanamh leatsa. - Give name, address and phone number(s) of a person who is authorised to act on your behalf if you cannot be contacted, in a case of emergency.
Stair do shláinte - Medical history *
An bhfuil ceann ar bith díobh seo ort? - Do you suffer from any of the following?
Required
Stair do shláinte - Medical history
Ar mhaith leat aon rud eile a chur in iúl dúinn maidir le sláinte do pháiste? - Is there anything else you would like us to know about your child's health?
Panadol *
Tá cead ag mo pháiste Panadol a thógáint - My child is allowed to take Panadol
Required
Cóireáil leighis éigeandála - Emergency mediacal treatment
Más rud é go bhfuil gá le cóireáil leighis éigeandála nó le máinliacht agus nach féidir teagmháil  a dhéanamh liom féin nó leis an duine go bhfuil údarás tugtha agam di / dó, tugaim cead
d’údaráis an choláiste i gcomhairle leis an bhfoireann leighis pé
socraithe a dhéanamh atá riachtanach chun beatha agus sláinte
mo mhic/m’iníne a chaomhnú. - If my child requires urgent medical treatment or surgery during the course and provided I or the person authorised to act on my behalf cannot be contacted, I give permission to the College authorities together with the appropriate medical personnel, to make any decision deemed necessary for the welfare of  my child.
*
Required
Aon rud eile ar mhaith leat a chur in iúl dúinn? - Anything else you would like us to know?
Más mian leat aonní eile a chur in iúl dúinn breac síos anseo é, le do thoil - If there is anything else you would like us to know, please write it down here
Nóta - Note
Tá tuismitheoirí/caomhnóirí freagrach as aon chostas breise le linn an chúrsa cosúil le billí dochtúra/cógaslainne 7rl.,
costais bhreise taistil agus aon chostas eile nach bhfuil san
áireamh sa phacáiste. - Parents or guardians are responsible for all extra costs incurred, i.e. for doctor/chemist
bills, additional travelling & other expenses incurred during
their child’s stay not included in the package.
Deimhniú - Confirmation *
Léigh rialacha Choláiste Phobal Chléire ar http://www.colaistephobalchleire.ie/rialacha.html (Béarla nó Gaeilge) nó inár mbróiséar, le do thoil. - Please read the regulations of Coláiste Phobal Chléire on http://www.colaistephobalchleire.ie/rialacha.html or in our printed brochure
Required
An chéad chéim eile - The next step
Ní mór duit deimhniú i scríbhinn a chur chughainn chun an próiseas cláraithe a chríochnú. - You have to send us a written confirmation to finish the registration process.

Seoladh - Address:
An Rúnaí
Coláiste Phobal Chléire
An Sciobairín
Co. Chorcaí
Deimhniú i scríbhinn - Confirmation by letter *
Deimhnigh go gcuirfidh tú litir chughainn tar éis duit an fhoirm seo a chur ar aghaidh ina mbeidh an t-eolas seo a leanas: - Please confirm that you will send a written confirmation after posting this online form, which will contain the following information:
Required
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