Òganan Dhùn Èideann

1. Child Details

Title

Forename:

Middle Name(s):

Surname:

Known as:

Gender:

Date of Birth:

Start date:

Postcode:

Address Line 1:

Address Line 2:

Religion

Ethnicity

First Language

Additional Language(s)

Any specific likes/dislikes or any other relevant information we should be aware of?

Bill Payer details

Bill Payer Title:

Bill Payer Forename:

Bill Payer Surname:

Bill Payer Known As:

Bill Payer Relationship to Child:

Bill Payer Gender:

Bill Payer Telephone (Home):

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Bill Payer Telephone (Mobile):

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Bill Payer Email Address:

Billing Address

Billing Postcode:

Billing Address Line 1:

Billing Address Line 2:

4. Contacts

Parent/Carer 2 Details

Parent/Carer 2 - Title:

Parent/Carer 2 - Forename:

Parent/Carer 2 - Surname:

Parent/Carer 2 - Known As:

Parent/Carer 2 - Relationship to Child:

Parent/Carer 2 - Gender:

Parent/Carer 2 - Email:

Parent/Carer 2 - Telephone Number:

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Parent/Carer 2 - Postcode:

Parent/Carer 2 - Address Line 1:

Parent/Carer 2 - Address Line 2:

Emergency Contact 1

Contact 1 - Title:

Contact 1 - Forename:

Contact 1 - Surname:

Contact 1 - Known As:

Contact 1 - Relationship to Child:

Contact 1 - Gender:

Contact 1 - Email:

Contact 1 - Telephone Number:

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Please note 4 different contact numbers need to be provided.

Contact 1 - Postcode:

Contact 1 - Address Line 1:

Contact 1 - Address Line 2:

Emergency Contact 2

Contact 2 - Title:

Contact 2 - Forename:

Contact 2 - Surname:

Contact 2 - Known As:

Contact 2 - Relationship to Child:

Contact 2 - Gender:

Contact 2 - Email:

Contact 2 - Telephone Number:

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Please note 4 different contact numbers need to be provided

Contact 2 - Postcode:

Contact 2 - Address Line 1:

Contact 2 - Address Line 2:

5. Health/Doctor

Doctor's Name:

Doctor Surgery Name:

Doctor Postcode:

Doctor Address Line 1:

Doctor Address Line 2:

Doctor Telephone Number

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Enter telephone number

Does your child have any additional support needs/disabilities or requires additional assistance?

Yes (please give details below)

Not Known

If yes, please list them here:

Health Visitor Name (Early Years Only):

Health Visitor Number (Early Years Only):

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Enter telephone number

9. Terms of Service

Please read our Terms and Conditions below:

Terms and Conditions for Òganan Dhùn Èideann

Why you should read them:

Please read these terms carefully before you accept our offer of a place at the school/centre for your child. These terms tell you who we are and how and on what basis the school/centre will provide educational services.

The standard terms and conditions:

If a place is offered, parents or anyone else with parental responsibility will be required (as a condition of accepting the place) to accept and be bound by Òganan Dhùn Èideann's Terms and Conditions.

Declaration: I have read and agree to the Booking Terms and Conditions

Yes

Full name of Parent/Carer:

Digital signature:

Clear

Name

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Òganan Dhùn Èideann - OOSCRegister Now / Clàraich An-Dràsta

1. Child Details

3. Billing

2. Contracts

4. Contacts

5. Health/Doctor

6. Dietary Needs

7. Permissions/Other

Privacy and Data Protection:

Consent for Medical Advice or Treatment:

Consent for Outings:

8. Medicines

9. Terms of Service

Terms and Conditions for Òganan Dhùn Èideann