Family Last Name: ___________________________________________
Address: _________________________________________________________
City: __________________________ State: _____ Zip Code: __________
Home Phone: _______________________
Cell Phone: _______________________
Business Phone: ________________________
Email Address (preferred if available): ________________________________________
St. Andrew's Parish Member? Yes ____ No _____

Father's Name: ___________________________________________________
Mother's Name: ___________________________________________________

4. Student Name (English) :____________________________________
(Baptismal) :____________________________________
Date of Birth: ___________ Grade Level: _________

5. Student Name (English) :____________________________________
(Baptismal) : ____________________________________
Date of Birth: ___________ Grade Level: _________

6. Student Name (English) :____________________________________
(Baptismal) : ____________________________________
Date of Birth: ___________ Grade Level: __________

Emergency Contact Name: ________________________________________
Phone: _________________________________________

There will be a meeting immediately Divine Liturgy on October 9th to decide on a practice date and to discuss other troupe related matters. Please bring your registration form with you to this meeting. Dance practice will resume in mid-October following this meeting.