Saint John the Baptist Greek Orthodox Church, Anaheim, Dance Registration

HOUSEHOLD INFORMATION

Family Last Name:
Field is required!
Field is required!
Mother’s First Name:
Field is required!
Field is required!
Mother's Last name:
Field is required!
Field is required!
Mother’s Cell Phone:
Field is required!
Field is required!
Mother’s Email:
Field is required!
Field is required!
Father’s First Name:
Field is required!
Field is required!
Father's Last name:
Field is required!
Field is required!
Father’s Cell Phone:
Field is required!
Field is required!
Father’s Email:
Field is required!
Field is required!
Home Phone Number:
Field is required!
Field is required!
Home Address:
Field is required!
Field is required!
City
Field is required!
Field is required!
Zipcode
Field is required!
Field is required!
Emergency Contact Person:
First Name
Field is required!
Field is required!
Emergency Contact Person:
Last Name
Field is required!
Field is required!
Emergency Contact Person’s Phone Number:
Field is required!
Field is required!

For Parents

Please mark the committee(s) you are interested to volunteer in support the Saint John the Baptist Greek Orthodox Church, Anaheim Dance Ministry:
Field is required!
Field is required!
Do you have any special talents you would like to offer the dance ministry program?
i.e. sewing, knitting, prop making, etc.
Field is required!
Field is required!
Any suggestions or comments you would like to offer?
Field is required!
Field is required!

DANCER'S INFO

First name:
Field is required!
Field is required!
Last name:
Field is required!
Field is required!
Cell Phone:
Field is required!
Field is required!
Email address:
Field is required!
Field is required!
Date of Birth:
You Must Select The Year First, Then Month Then Day
Field is required!
Field is required!
Age at FDF:
0.00
Field is required!
Field is required!
if({dancer_age_at_fdf}<2):

Are you sure the Date of Birth is Correct? Select the Year First, then Month and Date.

endif;
Dance Group:
  • - select a option -
  • Unknown
  • Avra
  • Nea Zoe
  • Nea Elpida
  • Thiasos
  • Enotita
  • Dynami
- select a option -
Field is required!
Field is required!
Grade in 2021-2022 School Year:
  • - select a option -
  • PK
  • K
  • 1st Grade
  • 2nd Grade
  • 3rd Grade
  • 4th Grade
  • 5th Grade
  • 6th Grade
  • 7th Grade
  • 8th Grade
  • 9th Grade
  • 10th Grade
  • 11th Grade
  • 12th Grade
  • College/Young Adult
- select a option -
Field is required!
Field is required!
Would the dancer be interested in participating in a Choral Competition Group?
  • - select a option -
  • Yes
  • No
  • Maybe
- select a option -
Field is required!
Field is required!
Does your dancer have any medical issues/allergies?
  • - select a option -
  • Yes
  • No
- select a option -
Field is required!
Field is required!
If yes, please briefly explain:
Field is required!
Field is required!
Please list any regular medications and directions dance director should know of:
Field is required!
Field is required!
Insurance Carrier:
Field is required!
Field is required!
Policy Number:
Field is required!
Field is required!
Primary Doctor’s Name:
Field is required!
Field is required!
Doctor’s Phone Number:
Field is required!
Field is required!

To Register Additional Dancers Please click the Green + Sign

I would like to give a gift above & beyond my tuition to help support the Saint John the Baptist Greek Orthodox Church – Anaheim Dance Ministry and/or earmark this donation to financially assist another dancer in need.
  • - select a option -
  • 0
  • 25.00
  • 50.00
  • 100.00
- select a option -
Field is required!
Field is required!

Amount Due Including Registration and Tuition:

1St Dancer$0.00
Field is required!
Field is required!
Additional Dancer's$0.00
Field is required!
Field is required!
Donation$0.00
Field is required!
Field is required!
Total Due:$0.00
Field is required!
Field is required!
Number of Additional Dancer's0
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Emergency Authorization: I/We the undersigned dancer(s)/parent(s)/legal guardian(s) of the registered dancer(s), do hereby authorize the dance directors, parent representative(s) or parents of the group acting in the capacity or activity of supervisor/vehicle driver, as agents for the undersigned to consent to medical, surgical, or dental examination, treatment, etc. in case of emergency. I/We hereby authorize treatment and/or care of the registered dancer(s) at any hospital. If there is an emergency and I/We cannot be reached, please contact the emergency contact person stated above who is hereby authorized to act on the dancer’s behalf. By typing your name below, you are giving Legal Authorization for emergency care acknowledgement of disclaimer.
Enter Your Name Here
Field is required!
Field is required!
Select a date
Field is required!
Field is required!
Step 1

This form is the 1st step of the registration process. After clicking the “I Agree” button in red you will automatically be redirected to Step 2 for Payment Details.

Step 2

The second Step in the Registration Process is completing Payment Details. Payment can be made via Cash/Check Visa, MasterCard or AMEX.

Step 3

The 3rd and Final Step to completing your Registration is to complete the pdf form that was emailed to you. Please fill it out, sign it and return it to your Perspective Dance Director. One form is required per Dancer.