Campa Saoire Chois Fharraige

Foirm Iarratais - Application Form

Líon isteach an fhoirm seo, priondáil amach é agus cuir sa phost í mar aon le d'éarlas chuig :

Complete this form, print it out and post it with your deposit to :

Indreabhán

Co. na Gaillimhe

Tuismitheoir - Parent
Ainm - Name:
Seoladh - Address:


Teileafón - Telephone:
Fón Póca - Mobile:
Ephost - Email:
Íocaíocht Leis Seo - Payment Enclosed:
Tá rialacha an Champa Saoire léite agam agus glacaim leo. I have read the rules of Campa Saoire and I accept them.
Síniú Tuismitheora - Parent's Signature:	_____________________________
Gasúir - Children
Scoláire 1 - Student 1
Ainm - Name:
Dáta Breithe - Date of Birth:
Scoil - School:
Cúrsa - Course:
Bus - Bus:
Caighdeán Gaeilge - Standard of Irish:

Scoláire 2 - Student 2
Ainm - Name:
Dáta Breithe - Date of Birth:
Scoil - School:
Cúrsa - Course:
Bus - Bus:
Caighdeán Gaeilge - Standard of Irish:

Scoláire 3 - Student 3
Ainm - Name:
Dáta Breithe - Date of Birth:
Scoil - School:
Cúrsa - Course:
Bus - Bus:
Caighdeán Gaeilge - Standard of Irish:

Indreabhán. Co. na Gaillimhe, Éire, Teileafón (091) 593195 - E-Mail -