The Greek Orthodox Church of the Holy Cross

CHURCH OF THE HOLY CROSS
Youth Religious Education Registration Form, 2011-2012

900 Alameda, Belmont, CA 94002-1604
phone:(650) 591-4447
fax: (650) 508-9846
www.goholycross.org

NOTE: If you registered last year you only need to fill in the information that has changed. Please be sure to include the student's first and last name.

Student First Name:

Student Last Name:

Address:

City:

Zip:

Home Phone:

Student's Email:

Female/Male:

Birthdate:

(ie. 01/01/2008)

Baptismal Name:

Baptismal Date:

(ie. 01/01/2008)

Patron Saint:

KNOWN ALLERGIES:

Grade in Sunday School:

Grade in School:

If young person is interested in participating in the following activities, please check appropriate box

YOUTH CHOIR
2^nd–12^thGrades

ACOLYTES
11 years and older

* e-mail addresses may be used to contact students about weekly lessons and upcoming events.

PARENT INFORMATION:

Mother:

Email Address:

Home Phone:

Other Phone:

Father:

Email Address:

Home Phone:

Other Phone:

IN CASE OF EMERGENCY:

Person to Call:

Name:

Phone:

Relationship:

Name:

Phone:

Relationship:

Doctor/Insurance Information:

Doctor:

Phone:

Insurance Carrier:

Insurance #:

WAIVER OF RESPONSIBILITY:

I do hereby release the Greek Orthodox Church of the Holy Cross and The Greek Orthodox Diocese of San Francisco from any liability for any injury that he/she may incur participating in Religious Education and all its activities. I agree to release my child for emergency medical treatment if I cannot be contacted.

Parent/Guardian Signature:

Date:

(ie. 01/01/2008)

PARENT CONTRACT:

I will assist in the following ways to ensure the success of the Holy Cross Youth Religious Education Program by committing to the following:
1) Regular attendance at Sunday Divine Liturgy (starting at 10AM);
2) Assist with the Holy Cross Youth Religious Education Program in at least 1 area (or more):

     Religious Education:
          Saturday of Lazarus
          Good Friday Retreat
          Substitute Teaching
          Classroom Helper
          Christmas Program

I have checked those events in which I can assist.

Parent/Guardian Signature:

Date:

(ie. 01/01/2008)

** e-mail addresses may be used to contact students about weekly lessons and upcoming events.

The registration fee is $10.00 per family. Please remit payment to the church office at your earliest convenience.