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Christian
Brothers Primary School, Wexford Application Form Name
of Pupil: _____________________________________ Address:______________________________________________________________ Date
of Birth: _________________ Parents’ Names and Occupations:_______________________________________ ________________________________________________________________________ Phone:
(Home)______________ (Work)_________________ (Other)____________ Date
of Admission: ________________ Previous
School:_____________________________ Class
Repeated: _________
Does
the pupil have any Special Educational Needs?: ___________ If
yes please give
details:___________________________________________________ ______________________________________________________________________ Health Family Doctor: _____________________________ Relevant information regarding sight, hearing and speech:________________________ _____________________________________________________________________ Any
other illness or disability: _____________________________________________ _____________________________________________________________________ Please
supply any other relevant information to the School Principal. Parents’
or Guardians’ signatures: ___________________ ____________________ Date:
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