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Parent’s Information
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Home
About Us
Programmes
How to Apply
Our Team
Parent’s Information
Contact Us

026 -43344

Home
About Us
Programmes
How to Apply
Our Team
Parent’s Information
Contact Us

Menu

Home
About Us
Programmes
How to Apply
Our Team
Parent’s Information
Contact Us

(026) 43344

Apply Now

If you would like to apply don’t hesitate to fill in the form below

Childs Name *

First

Last

Date of Birth *

Home Address *

Home Phone No *

Date of Commencement(Creche) *

Date of cesation of creche *

Date of commencement of Pre-school *

Date of cesation of Pre-school *

Name of Parent/Guardian 1 *

Workplace address *

Workplace phone number *

Mobile number *

Email *

Name of parent/guardian 2

Workplace phone number

Mobile phone number

Person(s) Authorised to collect (other than parents/guardian)

Name *

Contact Number *

Name *

Contact Number *

Personal Details

Family Doctor *

Contact Number *

Immunisation Record:

BCG *

6 in 1 PCV Men B Rotavirus 2 Months *

6 in 1 Men B Rotavirus 4 months *

6 in 1 PCV Men C 6 months *

MMR Men B 12 Months *

Men C PCV HIB 13 Months *

4 in 1 MMR 4-5 yrs *

Did your child ever have the following? *

Chicken Pox
Whooping Cough
Mumps
Rubella

Does your child suffer from any medical conditions, disabilities or allergies, or dietary requirements? *

Prescription Medicines

I consent to prescribed medicines by oral administration and others (inhalers/ injectable adrenaline) in accordance with the policy and procedure of the service. NB: Parents will always be asked to complete a medical consent administration form prior to the medicines been given. Parent/Guardian’s E-Signature: *

Date / Time of signature *

Date

Time

Antipyretic / Anti-Febrile Medication

I consent to the administration of teething gels and temperature control medication (Calpol/Paralink) in accordance with the policy and procedures of the service. NB: Parents will always be informed when medication has been administered to their child. Parent/Guardian’s signature: *

Date / Time of signature *

Date

Time

Allergies

Allergies My child has an allergy to a temperature control medication (e.g. Calpol/paralink) *

Yes
No

Infectious Diseases

Infectious Diseases I will notify the service as soon as possible if my child is diagnosed with an infectious disease e.g. measles, viral meningitis, Diphtheria, Whooping cough, COVID 19. Parent/Guardian’s signature *

Date / Time *

Date

Time

In the case of of an emergency do you consent to have your child taken to doctor/hospital? I/We give permission to the staff/management of Clann Aire to act on my behalf in the case of an emergency or accident and to take such actions as may be necessary for the benefit my child. *

Yes
No

E-signature *

Date / Time *

Date

Time

In hearby give permission for my child's photograph to be taken and used for promotion of our services in newspapers or local or national publications *

Yes
No

In hearby give permission for my child's photograph to be taken and used for promotion of our services on our website *

Yes
No

E-signature *

Date / Time *

Date

Time

Photo and Video Permission I give permission for (childs name) to be photographed or video recorded due to behaviour issues. This will always be discussed with the parent first. *

Photographs/videos may be used for: *

Documenting learning e.g. Observations, Learning Stories
TUSLA Early Years Inspectorate/ DES Inspectorate
Service Evaluation
Displays and information
Share a photo on Child Paths or Class DoJo with other parents of your child playing with the children in their pod/group/class

If we would like to use a photo / video of your child for another purpose, we will ask for specific permission.

Any Comments you may have

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Apply Now
Contact Us

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About
Apply Now
Contact Us

Garranenagappul,
Clondrohid, Co. Cork

Phone: (026) 43344

clannairecreche@gmail.com

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