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Child's Full Name

Child's name in Greek (if applicable)

Address (Street, City, State, Zip Code)

Phone number

Email

Date of Birth

Age

Grade in school

Orthodox Baptismal Date

Baptismal Name

Parent contact (Full name, Cell number)

Emergency Contact (other than parent) (Full name, Cell 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, the supervising teacher has my permission to seek medical help.

your parent) Date

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