Saint Patrick's B.N.S., Cork.

DATABASE INFORMATION FORM:

Pupil's Name: ______________________________________________________

Date of Birth: ______________________

Full Address: ______________________________________________________

Mother's Name: ____________________________________________________
Contact No._______________________

Father's Name: _____________________________________________________
Contact No._______________________

Current Year in this school: ___________________________________________

Teacher's Name: ___________________________________________________



If your child is sick in school, has an accident or is not collected at the usual time whom should we contact? If the contact person is not a parent what is their connection to the child. (Grandparent, child-minder, neighbour etc)?

1st choice: Name: __________________________________________________

Connection to child: ________________________________________

Phone Number: ___________________________________________

2nd choice: Name: __________________________________________________

Connection to child: _______________________________________

Phone Number: ___________________________________________

3rd choice: Name: __________________________________________________

Connection to child: _______________________________

Phone Number:___________________________________________


Medical Information

Does your son wear glasses? Yes/ No

Does your son have any known hearing difficulties? Yes/ No

Does your son suffer from any for the following:

Allergies: Yes/ No
(Please give details)
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Asthma: Yes / No
(Please give details)
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Epilepsy: Yes/ No
(Please give details)
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Is your son on any medication which must be taken during the school day?
(Please give details)
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Please give details of any other medical conditions:
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