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Foirm Iarratais Coláiste Chamuis 2010

Please do not complete this form without reading our website. Fill out items 1—18 and send completed form to: An Rúnaí, Coláiste Chamuis , Indreabhán, Co na Gaillimhe, le héarlais €200.

1. Name in Irish
2. Gender
3. Date of Birth

4. Address in Irish

5. Home Phone
Parent's Mobile Student's Mobile

6. Name and address of person in loco parentis should parents not be contactable

7. Phone Number of the Above

8. School 9. Year

10. Name of Irish Teacher

11. Preferred Course Nóta: Cúrsa A at Ros a' Mhíl only

12. Preferred Centre
13. Were you at Coláiste Chamuis before?

14, If so, please indicate (a) year (b) centre

Did you hold any of these positions. If none select "Ní Raibh"

House in 2008 in 2009

15. Were you in any other college?

16. Mention friends coming on course

17. Medical card number (if applicable)

I (the above-named student) promise that I will complete the full course, I will accept all the rules of the course; I accept travel arrangements of Coláiste Chamuis.

18. Declaration

We accept all the rules and the student will attend the full course.

Students Signature:

Parents Signature 1:

Parents Signature 2:

19. Date: