Scoil

Chill

Ruadhin

Brooklodge National School, Glanmire, Co Cork,

Tel: 021-4866044, Fax: 021-4866051; e-mail: scr@brooklodgens.net Website: www.brooklodgens.net
Principal: Eoghan OConnor;
Rolla: 17505 B

Expression of Interest
in Enrolling in Scoil Chill Ruadhin for
September 20_____
Name of Child: _________________________________________________________________________

Address: ________________________________________________________________________________

Date of Birth:_______________________________________________________________

Place of Birth :__________________________________________________________________________

Parents/Guardians Name(s):_________________________________________________

Telephone Number (Land-Line):______________________________________________

Mobile Number:____________________________________________________________

Siblings already attending Scoil Chill Ruadhin:_________________________________

Please tick if no sibling is in this school

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Any information, medical or otherwise, regarding the child which may be relevant to the school

___________________________________________________________________________
___________________________________________________________________________

Signature of Parent(s) :_______________________________________________________

Date:_______________________________