GOYA Registration Form

St. Nicholas Greek Orthodox Church, Ann Arbor, Michigan
GOYA & Levendia Registration Form

This form is to register for either GOYA or Levendia Dance or both groups.
This form is submitted successfully, ONLY when you receive an email that contains a link that allows you to edit this form again (if needed).

Registration fee (provide to an Advisor or church office mailbox) for the year is $ 35.00, however, scholarships are available. No one will be refused participation due to financial strain. Please talk with Fr. Nick for scholarship.

GOYAn Information
Child Name*

First NameLast Name
Grade*
Birth Date*

MonthDayYear
Baptismal Name
Name Day
Feast date (e.g., 'Jan 6'), or Feast name (e.g., 'Easter')
GOYAn's Email
example@example.com
GOYAn's Cell Number (If Applicable)

Area CodePhone Number
Medical Information

The information below will only be shared with appropriate staff.
Health conditions *
If not applicable, please write: 'NONE'
Allergies *
If not applicable, please write: 'NONE'
Health (other)
If not applicable, please leave empty.

Family Contact Info
Family E-mail*
This email will be used for all GOYA communications in addition to the student email listed above.
Home Phone*
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Medical Providers
Medical Professional Contact Information

If the designated parties are not available, I understand appropriate emergency care deemed advisable by St. Nicholas school authorities or St. Nicholas youth advisors will be sought. Any special decisions appropriate to my child have been checked.
Physician Name*

First NameLast Name
Physician Phone*
Dentist Name

First NameLast Name
Dentist Phone
Preferred Hospital*

Emergency Contacts
Emergency Contacts

Please list everyone we can call in case of an emergency or school closing. Note: if a parent/guardian is not available, we will call the next person on the list until someone is contacted.
Contact Name (1)*

First NameLast Name
Relationship (1)*
Phone Number (1)*
Contact Name (2)

First NameLast Name
Relationship (2)
Phone Number (2)
Contact Name (3)

First NameLast Name
Relationship (3)
Phone Number (3)
Contact Name (4)

First NameLast Name
Relationship (4)
Phone Number (4)