Enrolment Application Form 2026
Please ensure accurate completion and that you are in receipt of a legitimate/active offer from St. Mary's High School.
Do you accept this offer of enrolment from St. Mary's High School?
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Accept
Reject
Daughter's Surname
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Christian Name(s):
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As per Birth Certificate
Name Called
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Date of Birth
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/
Day
/
Month
Year
Date
PPS Number
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1234567XX
Address
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Street Address
Street Address Line 2
City/Town/Village
County
Eircode
Is correspondence address different
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Yes
No
Alternate Address
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Street Address
Street Address Line 2
City/Town/Village
County
Eircode
Email
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Please ensure mail adress is accurate
Country of Birth
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Religion
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Ethnic or Cultural background
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Please Select
White Irish
Irish Traveller
Roma
Any other white background
Black or Black-African
Black or Black Irish - any other Black background
Asian or Asian Irish - Chinese
Asian or Asian Irsih - Any other Asian background
Other including mixed background
No consent
Student Medical Card (not GP Card)
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Yes
No
I agree to give permission to the school nominated below to release in confidence relevant information regarding my daughter to St. Mary's High School.
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I Agree
Primary School
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Please Select
St.Brigid’s Presentation National School
Scoil Naomh Eoin N.S. Ballincurrig
Bishop Ahern N.S. Leamlara
Ballintotis N.S.
Scoil Iosagain N.S. Aghada
Scoil Realt na Mara Ballycotton
Ballycroneen N.S.
St.Joseph’s N.S. Castlemartyr
St.Colman’s N.S. Cloyne
St.Peter’s N.S. Dungourney
Gaelscoil Midleton
Kilcredan N.S.
Holy Family N.S. Shanagarry
St.John the Baptist N.S. Midleton
Scartleigh N.S. Saleen
Whitegate N.S.
Inch N.S.
St Fergal’s N.S. Killeagh
Glounthaune N.S.
Knockraha N.S.
Midleton Educate Together N.S.
Scoil na N-Óg Glanmire
Kyle National School
Other
Other School name
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Name of Family Doctor
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Details of any illness or health problems (that school should know about)
Please upload any Medical and or Psychological Reports the school should have. If you are accepting a Hub (ASC Unit) position you must upload the necessary documentation here as per our admissions policy. PLEASE ENSURE ALL UPLOADED DOCUMENTS ARE LEGIBLE.
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Exemption from Irish
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Yes
No
Please include copy of Exemption letter
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of
Parent/Guardian full name
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Phone number
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Parent/Guardian Relationship
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Please Select
Aunt
Brother
Father
Grandfather
Grandmother
Mother
Other
Self
Sister
Social Worker
Stepfather
Stepmother
Uncle
Parent/Guardian full name
*
Phone number
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Parent/Guardian Relationship
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Please Select
Aunt
Brother
Father
Grandfather
Grandmother
Mother
Other
Self
Sister
Social Worker
Stepfather
Stepmother
Uncle
Mother's Maiden Surname
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Names of siblings presently in St. Mary's High School if applicable?
Upload a copy of your daughter's Birth Certificate
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Choose a file
Cancel
of
Upload a passport type photograph of your daughter
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Cancel
of
Is the student awaiting an offer of admission from another school?
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Yes
No
Please provide details. (School, etc.)
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Has the student accepted an offer of admission from another school(s)?
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Yes
No
Please provide details. (School, etc.)
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I/we agree that by accepting a place at St. Mary's High School our daughter is obliged to abide by the School Code of Behaviour, School Procedure, School Rules and that she undertakes to obey all reasonable instructions as they may arise — see www.stmarysmidleton.com
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I agree
Data Protection
The school is a Data Controller under the Data Protection Acts 1988 and 2003. Personal data supplied on the enrolment form will be used for the purposes of student enrolment, registration, administration, child welfare and to fulfil any other legal obligations. While the information provided will generally be treated as confidential to the school, from time to time it may be necessary for the school to exchange personal data on a confidential basis with other bodies including the Department of Education & Skills, Department of Social Welfare & Family Affairs, An Garda Siochana, the Health Service Executive, National Educational Welfare Board. Contact details will also be used to notify you of school events and activities. The school relies on parents/guardians to provide us with accurate and complete information and to update us in relation to any change in the information provided. You should write to the Principal should you wish to update or access your child's personal data. Please see the Department of Education & Skills website at www.educationde. for a copy of a notice to parents, guardians, and students over 18 from the Department outlining how personal data of students in this school is returned to the Department of Education & Skills, and how this data is fairly processed and in compliance with the Data Protection
Signed : Parent/Guardian
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Signed : Parent/Guardian
Fee is non-refundable, please ensure you are in receipt of a legitimate offer before continuing with payment.
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Administration Fee
Administration Fee
€50.00
€
50.00
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