GOYA Registration Form

GOYAn Information

Name *

Date of Birth * +

Address *

City *

State *

Zip *

Home Phone *

GOYAn Cell Phone *

GOYAn Email Address *

Parent Name *

Parent Cell Phone *

Parent Email Address *

Emergency Contact *

Medical Conditions *

Allergies *

Yes

Medical Insurance *

Policy Number *

Participation fee is $40. Please make checks payable to St. Paraskevi GOYA

Please note the our main form of communication will be via email & Facebook

I/We the undersigned parent(s), or legal guardian(s), of the above minor, know that I may not be available to authorize medical care of said minor in the event of an emergency. I wish to appoint the GOYA advisors of Saint Paraskevi Greek Orthodox Church to act in my absence and to give such authorization. This authorization is intended to give the right to GOYA advisors to give consent to medical care.

Parent/Guardian Signature *

clear

Date *

We will be participating in many fun activities throughout the year. We appreciate parent volunteers to help out at various times throughout the year. Please consider volunteering.

We also encourage all GOYA families to become stewards of St. Paraskevi

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