Little Angels of St. Paraskevi Registration

For Ages: 6 weeks to Four Years Old

Contact Info

Mother First and Last Name: *

Father/ Guardian First and Last Name: *

Home Address: *

Home Telephone: *

Cell Phone: *

Email: *

Please note: Our main communication will be through email and our Facebook Group: Little Angels of St. Paraskevi

Child's Info

Child’s Name: *

Birthdate: *

Child’s Name:

Birthdate:

Child’s Name:

Birthdate:

Emergency & Medical Info

Emergency Contact: *

Relationship: *

Home Telephone: *

Cell Phone: *

****Please keep us informed of any food allergies****

Does your child have any medical conditions or special needs that we should be made aware of? If so, please explain:

Medical Release: In the event of sudden illness, injury or emergency, I authorize the Little Angels of St. Paraskevi, the Board/Advisors to administer first aid and/or secure medical care if necessary during a Little Angels meeting/function. This includes medical care and treatment by a first aid station, physician or hospital.

Parent/Guardian Signature: *

clear

Date: *

Payment Info

Registration Fee: $40 per family.

Check box below to pay online. When you click the "Next" button below, you will be directed to Paypal to complete payment with a credit card(you do not need a Paypal account to do this). Note: You must continue to Paypal and enter your card info for the registration to take effect.

Registration Fee per family($40)

If you prefer to pay with a check, click here for a printable PDF of the registration form.

Please return completed form and payment to:

Little Angels of St. Paraskevi, 1 Shrine Place, Greenlawn NY 11740

Attn: Christine Siounis or Katerina Stathakos

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