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

HOUSEHOLD INFORMATION

Family Last Name:
Mother’s First Name:
Mother's Last name:
Mother’s Cell Phone:
Mother’s Email:
Father’s First Name:
Father's Last name:
Father’s Cell Phone:
Father’s Email:
Home Phone Number:
Home Address:
Emergency Contact Person:
Emergency Contact Person:
Emergency Contact Person’s Phone Number:

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:
Do you have any special talents you would like to offer the dance ministry program?
Any suggestions or comments you would like to offer?

DANCER'S INFO

First name:
Last name:
Cell Phone:
Email address:
Date of Birth:
Age at FDF:
0.00
Dance Group:
  • - select a option -
  • Unknown
  • Avra
  • Nea Zoe
  • Nea Elpida
  • Thiasos
  • Enotita
Grade in 2019-2020 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
Would the dancer be interested in participating in a Choral Competition Group?
  • - select a option -
  • Yes
  • No
  • Maybe
Does your dancer have any medical issues/allergies?
  • - select a option -
  • Yes
  • No
If yes, please briefly explain:
Please list any regular medications and directions dance director should know of:
Insurance Carrier:
Policy Number:
Primary Doctor’s Name:
Doctor’s Phone Number:

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

Amount Due Including Registration and Tuition:

1St Dancer$0.00
Additional Dancer's$0.00
Donation$0.00
Total Due:$0.00
Number of Additional Dancer's0
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.
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.