Back to School Agiasmos

Child's Full Name

Child's name in Greek (if applicable)

Address (Street, City, State, Zip Code)

would Parent permission

Phone number

Email

Date of Birth

Age

Grade in school

Date of Baptism

Baptismal Name

Parent contact (Full name, Home number, Cell number)

Emergency Contact (other than parent) (Full name, Phone number, Relation)

Allergies

Medical conditions / Concerns

Does child have EpiPen?

Is there anything you would like us to know about your child?

If I am not available, and a medical emergency arises, does the supervising teacher have my permission to seek medical help? (copy)

I give permission my child's picture to be uploaded for classroom projects, social media and/or the church website