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Greek School Online Registration Form

The Assumption Socrates Greek School begins on September 16, 2010. Classes start at 5:00 PM and conclude by 6:30 PM. Tuition is $225 per student annually, with a 10% discount privided for additional children in a family after the first. For more information please call Eleni at (480) 421-8853 or email elenitsa@msn.com . Please complete the form below and press "send" when completed.

A. Family Information

Family Last Name:

Mother's First Name

Mother's Work Phone (xxx) xxx-xxxx:

Mother's Cell Phone (xxx) xxx-xxxx:

Mother's Email Address:

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Father's First Name

Father's Work Phone (xxx) xxx-xxxx:

Father's Cell Phone (xxx) xxx-xxxx:

Father's Email Address:

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Street Address (Include Apt #):

City:

State / Province:

Zip / Postal Code:

Home Phone (xxx) xxx-xxxx:

B. Emergency Contact

Emergency Contact :

Relationship:

Emergency Phone:

C. Medical Information

Pediatrician Name

Pediatrician's Phone

Medications/Allergies/Special Needs

D. Student Information

1. Child's Full Name

Date of Birth (MM/DD/YYYY)

Grade

Has your child attended Greek School before?   Yes No

If yes, where and what level?

Additional information for placing your child in the appropriate class:

2. Child's Full Name

Date of Birth (MM/DD/YYYY)

Grade

Has your child attended Greek School before?   Yes No

If yes, where and what level?

Additional information for placing your child in the appropriate class:

3. Child's Full Name

Date of Birth (MM/DD/YYYY)

Grade

Has your child attended Greek School before?   Yes No

If yes, where and what level?

Additional information for placing your child in the appropriate class: