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ST. ANDREW'S GREEK ORTHODOX CHURCH
THE THREE HIERARCHS GREEK SCHOOL
REGISTRATION FORM 2005-06
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: ___________________________________________________
1. Student Name (English) :____________________________________
(Baptismal) :____________________________________
Date of Birth: ___________ US School Grade Level: _________
Orthodox? Y / N
2. Student Name (English) :____________________________________
(Baptismal) : ____________________________________
Date of Birth: ___________ US School Grade Level: _________
Orthodox? Y / N
3. Student Name (English) :____________________________________
(Baptismal) : ____________________________________
Date of Birth: ___________ US School Grade Level: __________
Orthodox? Y / N
Emergency Contact Name: ________________________________________
Phone: _________________________________________
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