2016—2017
REGISTRATION FORM
Family Last Name ________________________
Last Name in Greek_______________________
Pythagoras Greek School
1st Child
Name:
The Greek Orthodox
Church of Saint Demetrios
Elmhurst, Illinois 60126
PGS
Mon/Wed Program
Pre K thru 6th Grade
4:30 p.m.—6:30 p.m.
Classis Begin August 29th
1st Child - $775
2nd Child - $750
3rd Child - $725
4th Child - Free
PSGS
Saturday Program
Pre K thru 6th Grade
9 a.m.—1 p.m.
Classes Begin September 10th
1st Child - $825
2nd Child - $800
3rd Child- $775
4th Child - Free
3-1/2 year olds
9 a.m.-12 p.m.
$425
Teen Track
7th thru 10th Grade
10:30a.m.-1:00p.m.
$450
No Teen Track Discount
Please Note:
If a child is not pre-registered by
August 1, 2016, a $100 fee will be
added to tuition costs.
$50 discount per family if paid in full by
August 1, 2016.
Supply Fee of $40 per child due
at registration.
2nd Child
Name:
3rd Child
Name:
4th Child
Name:
Age:
Age:
Age:
Age:
Date of Birth
Date of Birth
Date of Birth
Date of Birth
Grade:
Grade:
Grade:
Grade:
Baptismal Name
Baptismal Name
Baptismal Name
Baptismal Name
Feast Day
Feast Day
Feast Day
Feast Day
____________
Program
_____________
___________
Program
Program
____________
Program
I, the undersigned parent/guardian, do hereby assume responsibility for the tuition and any other related
costs imposed by the Greek Orthodox Church of Saint Demetrios for the 2016—2017 school term. I also
agree to comply to the following rules and hereby assume all of the following costs pertaining to my status at the Greek Orthodox Church of Saint Demetrios in Elmhurst, Illinois (please check parish status and
sign below; verification of 2016 stewardship will be administered by church office personnel
only.
________My family and I are stewards in good standing at Saint Demetrios for 2016.
______ My family and I are stewards of another Greek Orthodox Church and do not wish to become
stewards of St. Demetrios. We understand and agree to pay the non-steward fee of $500 (in addition to
the tuition) and all other related expenses.
_______ We hereby assume responsibility for the tuition related fees and balances for Pythagoras Greek
School, and agree to provide prior to the beginning of the school year proof of (a) stewardship for the
2016 calendar year or (b) payment of the non-steward fee.
PTO Activity Fee of $10 per family
due at registration (made out
to PT0).
______________________________
Signature
Graduation Fee of $30 per child
enrolled in 6th Grade due at
Registration (made out to
PTO).
My child/ren is baptized in the Orthodox faith, and is able to participate in the sacraments of the Church.
I hereby verify, with my initials____________
Pre-registration requires:
Deposit of $75 per child; payment in full of 2016 Stewardship, ACH set up or Non
Stewardship fee.
____________________
Date
If not baptized in our faith, please indicate NO_______
CONTINUE to BACK SIDE
The Greek Orthodox Church of Saint Demetrios
893 N. Church Road, Elmhurst, Illinois 60126
Tel: 630.834.7010 ~ Fax: 630.834.7256
Website: www.saintdemetrioselmhurst.org
Registration Form 2016—2017 School Year
Father’s Name:__________________________________
Mother’s Name_____________________________
Address________________________________________
Address___________________________________
City: __________________________________________
City: _____________________________________
State/Zip_______________________________________
State/Zip__________________________________
Home Phone: ___________________________________
Home Phone: ______________________________
Cell Phone:_____________________________________
Cell Phone:________________________________
Work Phone: ___________________________________
Work Phone: ______________________________
E-Mail Address___________________________________
E-Mail Address_____________________________
Emergency Contact ______________________________
Relationship to Child/ren______________________
Phone Number/Home_____________________________
Cellular____________________________________
I give my child permission to attend the Pythagoras Greek School of The Greek Orthodox
Church of Saint Demetrios in Elmhurst - IL , further, I absolve The Greek Orthodox Church of
St. Demetrios in Elmhurst - IL, the PGS, staff, faculty, Parish Council, School Board, of all and
any damages or responsibilities in case of illness or accident.
In the event that neither I, nor my spouse, or specified emergency contact can be reached in
an emergency, I give permission to call a doctor or arrange emergency transportation and
treatment at the nearest hospital, if such treatment seems indicated.
Finally, I agree to sign up with TADS online tuition payment system and acknowledge the
following payment plans.
* Payable in full at time of registration or TADS setup.
* Payable in 3 equal installments (TADS setup, 11/2016 and 2/2017)
* Payable in 4 equal installments (TADS setup, 11/2016, 12/2016 and 2/2017)
* Payable in 5 equal installments (TADS setup, 11/2016, 12/2016, 1/2017 and 2/2017)
* Church office: Only payments in full prior to the beginning of the school year may be
made by cash or check.
Parent Signatures:______________________________________________________
Date:___/___/___