2024 Hellenic Academy Registration

Please tell us about yourself.

<h3>Please tell us about yourself.</h3>

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Your First Name

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Your Last Name

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Your E-mail Address

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Phone Number

Invalid phonenumber!

Cell Phone Number

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Your Address

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City

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Zipcode

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I am

a Current Pledged Steward

not a Current Pledged Steward

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Are you a steward elsewhere?

Yes

No

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At what other Parish are you a steward?

Other Parish

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Would you consider a Stewardship Pledge to St Sophia?

Yes

No

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Why?

Example: Distance from my house, Traffic, I don't...

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Tell us about the Student(s)

<h3>Tell us about the Student(s)</h3>

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Students First Name

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Students Last Name

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E-mail Address

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Phone Number

Invalid phonenumber!

Date of Birth

Select a date

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Age on 1st day of School (9/14/24)

0.00

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if({age}<2): <p><strong><span style="color: #800000;">Are you sure the Date of Birth is Correct? Select the Year First, then Month and Date.</span></strong></p> endif;

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If yes, please briefly explain:

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Health Insurance Carrier

Example: Blue Cross

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Policy Number

Example: BAA123987Z

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Doctors Name

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Doctors Phone Number

Invalid phonenumber!

Emergency Contacts First Name

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Emergency Contacts Last Name

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Emergency Contacts Phone Number

Invalid phonenumber!

Media:

I HEREBY GRANT St Sophia Cathedral permission to use the above student(s) written word, artwork and other student works, photograph and voice or other likeness, on it's website, Facebook and other social media sites and also in publications including brochures, video programs, sound recordings, newspaper and magazine articles or other audio/visual material relative to school news and events.

I DO NOT GRANT St Sophia Cathedral permission to use the above student(s) written word, artwork and other student works, photograph and voice on it's website, Facebook or other social media sites or in any newspaper, magazine or other media source for publicity or recognition purposes.

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Emergency Authorization:

I the undersigned student(s)/parent/legal guardian of the registered student(s), do hereby authorize the teachers, directors, representative(s) of the St Sophia Cathedral acting in the capacity or activity of supervisor, as agents for the undersigned to consent to medical, surgical, or dental examination, treatment, etc. in case of emergency. I hereby authorize treatment and/or care of the registered student(s) at any hospital. If there is an emergency and I cannot be reached, please contact the emergency contact person stated above who is hereby authorized to act on the students behalf.

I the undersigned student(s)/parent/legal guardian of the registered student(s), do hereby authorize the teachers, directors, representative(s) of the St Sophia Cathedral acting in the capacity or activity of supervisor, as agents for the undersigned to consent to medical, surgical, or dental examination, treatment, etc. in case of emergency. I hereby authorize treatment and/or care of the registered student(s) at any hospital. If there is an emergency and I cannot be reached, please contact the emergency contact person stated above who is hereby authorized to act on the students behalf.

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Your Name

Signed by: ENTER YOUR NAME HERE

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Sign Here with your mouse or Touchscreen

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1st day of school

09/14/2024

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1st Student

$0

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Number of Additional Student(s):

0

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Additional Student(s)

$0

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Total Due

$0.00

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1st Student

$0

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Number of Additional Student(s):

0

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Additional Student(s)

$0

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Total Due

$0.00

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Hellenic Academy 2023-2024 Academic Year Student Registration

1324 S. Normandie Avenue, Los Angeles, CA 90006
(323) 737-2424

<img decoding="async" src="https://saintsophia.org/wp-content/uploads/2023/09/saint_sophia_logo.png"><h6>Hellenic Academy 2023-2024 Academic Year Student Registration</h6>1324 S. Normandie Avenue, Los Angeles, CA 90006<br />(323) 737-2424

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foreach(students_first_name):<br />
<h6>Student Information</h6>Name: <strong><%students_first_name%> <%students_last_name%></strong><br />
<%address%><br />
<%city%>, <%state%>, <%zipcode%><br />
Age <%age%> DOB: <%date%> <br />
Education: <%grade%> - <%level%> Level of Greek Language<br />
{steward}<br />
<%student_email%><br />
<%student_phone%><br />
<h6>Medical Info</h6>Does this student have any medical issues/allergies? <%medical%><br /><%medical_yes%><br />
Insurance: <%insurance%><br />
Policy Number: <%policy%><br />
Doctor Name: <%doctors_name%><br />
Doctors Ph: <%doctors_phone%><br />
<h6>Emergency Contact</h6>Name: <%emergency_first%> <%emergency_last%><br />
Phone: <%emergency_phonenumber%><br />
Relationship to Student: <%relation%><br />
Media Authorization:<br />
<%media%><br />Emergency Authorization:<br />
I the undersigned student(s)/parent/legal guardian of the registered student(s), do hereby authorize the teachers, directors, representative(s) of the St Sophia Cathedral acting in the capacity or activity of supervisor, as agents for the undersigned to consent to medical, surgical, or dental examination, treatment, etc. in case of emergency. I hereby authorize treatment and/or care of the registered student(s) at any hospital. If there is an emergency and I cannot be reached, please contact the emergency contact person stated above who is hereby authorized to act on the students behalf.<br />
<img decoding="async" src="<%signature%>" style="border-bottom: 2px dashed black" width="400" height="70"><br />
<p>Signed By <%emergency_auth%><br>{today_date}<br />Form Completed by: {first_name} {last_name}<br />{email}<br />{phonenumber} {cellphonenumber}</p><br />
<div class="super-shortcode super-field super-ungrouped super-pdf_page_break pdf-orientation-portrait"></div><br />
endforeach;

foreach(students_first_name):<br />
<h6>Student Information</h6>Name: <strong><%students_first_name%> <%students_last_name%></strong><br />
<%address%><br />
<%city%>, <%state%>, <%zipcode%><br />
Age <%age%> DOB: <%date%> <br />
Education: <%grade%> - <%level%> Level of Greek Language<br />
{steward}<br />
<%student_email%><br />
<%student_phone%><br />
<h6>Medical Info</h6>Does this student have any medical issues/allergies? <%medical%><br /><%medical_yes%><br />
Insurance: <%insurance%><br />
Policy Number: <%policy%><br />
Doctor Name: <%doctors_name%><br />
Doctors Ph: <%doctors_phone%><br />
<h6>Emergency Contact</h6>Name: <%emergency_first%> <%emergency_last%><br />
Phone: <%emergency_phonenumber%><br />
Relationship to Student: <%relation%><br />
Media Authorization:<br />
<%media%><br />Emergency Authorization:<br />
I the undersigned student(s)/parent/legal guardian of the registered student(s), do hereby authorize the teachers, directors, representative(s) of the St Sophia Cathedral acting in the capacity or activity of supervisor, as agents for the undersigned to consent to medical, surgical, or dental examination, treatment, etc. in case of emergency. I hereby authorize treatment and/or care of the registered student(s) at any hospital. If there is an emergency and I cannot be reached, please contact the emergency contact person stated above who is hereby authorized to act on the students behalf.<br />
<img decoding="async" src="<%signature%>" style="border-bottom: 2px dashed black" width="400" height="70"><br />
<p>Signed By <%emergency_auth%><br>{today_date}<br />Form Completed by: {first_name} {last_name}<br />{email}<br />{phonenumber} {cellphonenumber}</p><br />
<div class="super-shortcode super-field super-ungrouped super-pdf_page_break pdf-orientation-portrait"></div><br />
endforeach;

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2024 Hellenic Academy Registration

Please tell us about yourself.

Tell us about the Student(s)

If you are registering additional students use the green + sign to add their details.

Hellenic Academy 2023-2024 Academic Year Student Registration