REGISTRATION APPLICATION - Academic Year 2018-2019

Name of Student *
Name of Student
Date of Birth *
Date of Birth
Home Address
Home Address
Home Phone *
Home Phone
Mother's Name *
Mother's Name
Cell Phone *
Cell Phone
Work Phone
Work Phone
Father's Name *
Father's Name
Cell Phone *
Cell Phone
Work Phone
Work Phone
In Case of Emergency
In Case of Emergency
If above student is ill or an emergency situation occurs and student must be taken home, I give the permission to the following individuals to be called and have the student released to them.
Phone *
Phone
Name
Name
Phone
Phone
ALLERGIES *
If yes please describe
ALLERGIES Description
I give permission to have my child taken to the hospital in case of emergency.
I give permission to have my child's name printed in the program study directory and for photographs of my child/children to be used for the study program's promotional purposes.
Date
Date
Please SUBMIT PAYMENT TO COMPLETE REGISTRATION: $120 registration fee / family $400 tuition deposit / child PAYMENT OPTIONS: * Online Payment: Click the link below (add %2.9 paypal fee) * Drop in payment: check or cash

TUITION

Submitted Registration Applications will be printed and filed at Academy of Hellenic Paideia for the parent(s) to sign in person at their earliest convenience.