2023-2024 Greek School Registration – Cash Only – St. Demetrios Greek Orthodox Church

Family Information

Father*

Prefix First Middle Last Suffix

Father's Cell*

Father's Email*

Mother*

Prefix First Middle Last Suffix

Mother's Cell*

Mother's Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Backup Emergency Contact*

Prefix First Middle Last Suffix

Emergency Contact Phone*

Emergency Contact Relationship*

Number of Students*

Student #1

Name*

First Middle Last

Date of Birth*

Grade in American School*

Grade in Greek School*

Allergies*

Medical Conditions*

Student #2

Name*

First Middle Last

Date of Birth*

Grade in American School*

Grade in Greek School*

Allergies*

Medical Conditions*

Student #3

Name*

First Middle Last

Date of Birth*

Grade in American School*

Grade in Greek School*

Allergies*

Medical Conditions*

Student #4

Name*

First Middle Last

Date of Birth*

Grade in American School*

Grade in Greek School*

Allergies*

Medical Conditions*

Student #5

Name*

First Middle Last

Date of Birth*

Grade in American School*

Grade in Greek School*

Allergies*

Medical Conditions*

Media Consent

Saint Demetrios Greek Orthodox Church is making a concerted effort to promote the positive activities of our staff and students. This includes developing our website, advertising to school, and creating informational brochures. These publications may include images of our staff and students and their work. We do not publish students names.

Permission / Authorization*

I hereby authorize Saint Demetrios Greek Orthodox Church to publish photographs taken of/or students were created by the minor children named below for use in the Saint Demetrios Greek language school website and/ or printed publications.
I release Saint Demetrios Greek Orthodox Church from any expectations of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Saint Demetrios Greek Language school And church To use said photographs. Photos will consist of child actively learning and/or playing at Saint Demetrios Greek language school or church related events (e.g. Christmas program, Independence Day Parade, end-of-the-year picnic, etc...) and will not include names.
I acknowledge that since participation in publications and websites produced by St. Demetrios Greek Language School is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participating in any publication and website produced by St. Demetrios Greek Language School confers no rights of ownership whatsoever. I release Saint Demetrios Greek Orthodox Church and Greek language school, it’s directors, board members and employees from liability for any claims by me or any third-party connection with my participation or the participation of the undersigned minor children.

Additional Information

Is Greek spoken at home?*

Has your child had an formal Greek instruction?*

If Greek instruction, then please specify:

Would you like to be a member of the Parent Teacher Association (PTA)?*

Comments

Signature*

Affirmation*

I affirm that the above information is correct to the best of my knowledge, and hereby release Saint Demetrios Greek Orthodox Church of Upper Darby PA and St. Demetrios Greek Language School, its council members, officers, principal and agents of all liability in connection with the operation and conduct of the Saint Demetrios Greek School. I further acknowledge that enrolling my child(ren) commits our participation in all Greek School programs and activities.

Name

This field is for validation purposes and should be left unchanged.