All Saints Church School Registration Form
For registering students Pre-K through 5th Grade in the 2018-2019 All Saints Church School
Email address *
New or Returning Students (or both?) *
Required
Mother's Name *
First & Last Name; Address; Phone Number
Your answer
Father's Information *
First & Last Name; Address (if different than above); Phone Number
Your answer
Primary Address for Child(ren) *
If same as one or both parents, please state "Same as ____"
Your answer
Info - Student # 1 *
First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher
Your answer
Info - Student # 2 (if applicable)
First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher
Your answer
Info - Student # 3 (if applicable)
First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher
Your answer
Info - Student # 4 (if applicable)
First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher
Your answer
Info - Student # 5 (if applicable)
First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher
Your answer
Parent Participation & Authorization *
This form is for the purpose of enrolling a FAMILY into the All Saints Church School for this year (2018-19). Do you agree to do your best to ensure that your family regularly attends the Divine Services & Church School and strives to live an Orthodox Christian life at home?
Permission/Waiver for All Saints Church School *
Acceptance of these permission/waver stipulations are required to participate in the All Saints Church School. Your clicking of this checkbox is your confirmation that you have read, understand, and will abide by them.
Required
Publicity *
Please indicate whether or not you GRANT All Saints permission to use/publish any photo images, video or other media of your childre participating for the purspose of promoting the Church School in print or online.
Required
Family Health Insurance Information *
Insurance Company, Policy Number, & Insurance Company Phone Number
Your answer
Pediatrician/Primary Care Physician's Information *
Please indicate your child(ren)'s Doctor's Name & Phone Number
Your answer
Emergency Contacts *
Please provide the names & telephone number of those to call in case of emergency if you are not reachable.
Your answer
Medical History *
Any Special medical needs or concerns (Allergies, Conditions, Dietary Needs, Medications, etc.)?
Your answer
Any other helpful information about your child? *
Your answer
I represent that I am the parent and/or legal guardian of the above named child(ren) who is/are under 18 years of age. I have read the above form and am fully familiar with its contents including the Permission/Waiver section and the Release of Liability section. I give permission for the child(ren) named above to participate in the activities of All Saints Orthodox Church including any special events/activities. I hereby allow the participation of my child(ren) in the activities of All Saints Orthodox Church. By checking "I agree" in the checkbox below, I provide my consent to the Permission/Waiver section of this form, including the Release of Liability above, on behalf of my child, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. Additionally, by by submitting this form you hereby agree to accept the above terms. *
Required
I agree to remit the $20 fee per student (with a cap of $50 per family) on or before the date of the Church School Social (in 2018: Sep 9th) *
Please mail payment to All Saints Orthodox Church, 205 Scarborough Street, Hartford, CT 06105, or place it in the offering plate on or before the date of the Church School Social (in 2018: Sep 9th). If using Cash, please indicate on enevelope that it is for "Church School Registration: LAST NAME." Checks should be made payable to "All Saints Orthodox Church," with a memo Line: "Church School Registration." You may also pay online by going to our website and clicking "DONATE" on the blue pane on the right.
Required
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