{"id":533,"date":"2021-12-06T15:35:43","date_gmt":"2021-12-06T20:35:43","guid":{"rendered":"https:\/\/hellenicacademy.ca\/?page_id=533"},"modified":"2026-06-05T11:19:19","modified_gmt":"2026-06-05T16:19:19","slug":"registration","status":"publish","type":"page","link":"https:\/\/hellenicacademy.ca\/index.php\/registration\/","title":{"rendered":"Registration"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"533\" class=\"elementor elementor-533\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f613df4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f613df4\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bd8e039\" data-id=\"bd8e039\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-91b9fbb elementor-widget elementor-widget-heading\" data-id=\"91b9fbb\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Registration<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7ae2ed1 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7ae2ed1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-822db48\" data-id=\"822db48\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8ae001e elementor-widget elementor-widget-heading\" data-id=\"8ae001e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"><p><span style=\"font-family: var( --e-global-typography-primary-font-family ), Sans-serif; font-weight: var( --e-global-typography-primary-font-weight );\">PLEASE NOTE : \n<br><br>\nThe MHA program is now full for this 2023-24 school year.\nIf you would like to register your child(ren), please note that their name(s) will be placed on a waiting list should space become available.  \nPlease complete the registration form only at this time; do not make payment.\nThank you.<\/span><span style=\"font-family: var( --e-global-typography-primary-font-family ), Sans-serif; font-weight: var( --e-global-typography-primary-font-weight );\"><\/span><br><\/p><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9e57203 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"9e57203\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0534cf6\" data-id=\"0534cf6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4840480 elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"4840480\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<div align=\"center\"><div style=\"display:none\" class=\"fm-form-container fm-theme1\"><div id=\"fm-pages6\" class=\"fm-pages wdform_page_navigation \" show_title=\"false\" show_numbers=\"false\" type=\"none\"><\/div><form name=\"form6\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/533\" method=\"post\" id=\"form6\" class=\"fm-form form6  \" enctype=\"multipart\/form-data\"><input type=\"hidden\" id=\"counter6\" value=\"91\" name=\"counter6\" \/><input type=\"hidden\" id=\"Itemid6\" value=\"\" name=\"Itemid6\" \/><input type=\"hidden\" id=\"fm_shake6\" value=\"1\" name=\"fm_shake6\" \/><input type=\"text\" class=\"fm-hide\" id=\"fm_empty_field_validation6\" value=\"\" name=\"fm_empty_field_validation6\" data-value=\"bd736efb144d599cf463541431fbf5c4\" \/><div class=\"wdform-page-and-images fm-form-builder\" style=\"border-width: 1px;\"><div id=\"6form_view1\" class=\"wdform_page\" page_title=\"Student\/Parent Information\" next_title=\"http:\/\/www.hellenicacademy.ca\/wp-content\/plugins\/form-maker\/images\/next.png\" next_type=\"img\" next_class=\"wdform-page-button\" next_checkable=\"true\" previous_title=\"http:\/\/www.hellenicacademy.ca\/wp-content\/plugins\/form-maker\/images\/previous.png\" previous_type=\"img\" previous_class=\"wdform-page-button\" previous_checkable=\"false\"><div class=\"wdform_section\"><div class=\"wdform_column\"><div wdid=\"25\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><h1 style=\"text-align: center;\" data-mce-style=\"text-align: center;\">MHA Greek School Year 2026-27<\/h1><h1 style=\"text-align: center;\" data-mce-style=\"text-align: center;\"><strong>Registration &#038; Proof of Payment<\/strong><\/h1><h3 style=\"text-align: center;\" data-mce-style=\"text-align: center;\">(One per student)<\/h3><p style=\"text-align: left;\" data-mce-style=\"text-align: left;\"><strong>There are 2 steps to complete for each child.\u00a0 Read carefully before proceeding:<br><br>1. PAY FOR THE REGISTRATION<br><\/strong>Please click <a href=\"https:\/\/prophetelias.ca\/store\/greek-school\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-mce-href=\"https:\/\/prophetelias.ca\/store\/greek-school\/\"><span style=\"color: #a1d042;\" data-mce-style=\"color: #a1d042;\">HERE<\/span><\/a> to be redirected to Prophet Elias&#039; online store<br>When checking out, you will get an order number.\u00a0 Please use that order number and the purchase email to complete this form.\u00a0 <br>Otherwise, we won&#039;t be able to match it to the registration and your seat in the school is not secured.<br><br><strong>2. FILL OUT THIS FORM\u00a0<br><\/strong>This registration will be void without a valid order number entered and your seat in the school is not secured.<\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"67\" class=\"wdform_row\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_own_select\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_67_element6\" class=\"wdform-label\">Payment has been made<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 400px;\"><select class=\"wd-width-100\" id=\"wdform_67_element6\" name=\"wdform_67_element6\" ><option value=\"\" selected=\"selected\">Select value<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"68\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_68_element6\" class=\"wdform-label\">Order number<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 400px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_68_element6\"                           name=\"wdform_68_element6\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"90\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><center><h1 style=\"text-align: left;\" data-mce-style=\"text-align: left;\"><strong>Student Information<\/strong><\/h1><\/center><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"84\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_84_element6\" class=\"wdform-label\">Student First Name<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 400px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_84_element6\"                           name=\"wdform_84_element6\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"85\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_85_element6\" class=\"wdform-label\">Student Last Name<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 400px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_85_element6\"                           name=\"wdform_85_element6\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"63\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_date_fields\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_date_fields\" ><div class=\"wdform-label-section wd-width-100 wdform_date_fields wd-flex-row\">    <label  for=\"wdform_63_day6\" class=\"wdform-label\">Student&#8217;s Date of Birth<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_date_fields wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row wd-width-100 wd-align-items\"><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_63_day6\" name=\"wdform_63_day6\" class=\"wdform_select_day\" style=\"width: 60px;\" ><option value=\"\"><\/option><option value=\"01\" >01<\/option><option value=\"02\" >02<\/option><option value=\"03\" >03<\/option><option value=\"04\" >04<\/option><option value=\"05\" >05<\/option><option value=\"06\" >06<\/option><option value=\"07\" >07<\/option><option value=\"08\" >08<\/option><option value=\"09\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><label for=\"wdform_63_day6\" class=\"mini_label\">day<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_63_month6\" name=\"wdform_63_month6\" class=\"wdform_select_month\" style=\"width: 100px;\" ><option value=\"\"><\/option><option value=\"01\"   >January<\/option><option value=\"02\" >February<\/option><option value=\"03\" >March<\/option><option value=\"04\"  >April<\/option><option value=\"05\"  >May<\/option><option value=\"06\"  >June<\/option><option value=\"07\"  >July<\/option><option value=\"08\"  >August<\/option><option value=\"09\"  >September<\/option><option value=\"10\"  >October<\/option><option value=\"11\" >November<\/option><option value=\"12\"  >December<\/option><\/select><label for=\"wdform_63_month6\" class=\"mini_label\">month<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_63_year6\" name=\"wdform_63_year6\"  from=\"1990\" to=\"2021\" class=\"wdform_select_year\" style=\"width: 80px;\" ><option value=\"\"><\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><\/select><label for=\"wdform_63_year6\" class=\"mini_label\">year<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"87\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_87_element6\" class=\"wdform-label\">School Grade in 2025\/26<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_87_element6\"                           name=\"wdform_87_element6\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"88\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_88_element6\" class=\"wdform-label\">Greek School Grade 2025\/26<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_88_element6\"                           name=\"wdform_88_element6\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"81\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" value=\"\" id=\"wdform_81_element6\" name=\"h5\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"4\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_submitter_mail\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_submitter_mail\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_4_element6\" class=\"wdform-label\">Email address for confirmation email:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" style=\"max-width: 300px;\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_4_element6\" name=\"wdform_4_element6\" value=\"\" title=\"\" placeholder=\"\"   onchange=\"wd_check_email('4', '6', 'This is not a valid email address.')\" \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"5\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_address\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_address\" ><div class=\"wdform-label-section wd-width-100 wdform_address wd-flex-column\">    <label  for=\"wdform_5_street16\" class=\"wdform-label\"><b>Student Home Address<\/b><\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_address wd-flex-column wd-width-100\" style=\"max-width: 500px;\"><span class=\"wd-width-100 wd-address\" id=\"wdform_5_address_0\">                <input class=\"wd-width-100 wdform_5_address_0\" type=\"text\" id=\"wdform_5_street16\" name=\"wdform_5_street16\" value=\"\"  \/>                <label for=\"wdform_5_street16\" class=\"mini_label\">Street Address<\/label><\/span><span class=\"wd-width-100 wd-flex wd-flex-row wd-flex-wrap wd-justify-content\"><span class=\"wd-width-49 wd-address\" id=\"wdform_5_address_2\">                <input class=\"wd-width-100 wdform_5_address_2\" type=\"text\" id=\"wdform_5_city6\" name=\"wdform_7_city6\" value=\"\"  \/>                <label for=\"wdform_5_city6\" class=\"mini_label\">City<\/label><\/span><span class=\"wd-width-49 wd-address\" id=\"wdform_5_address_3\">                <input class=\"wd-width-100 wdform_5_address_3\" type=\"text\" id=\"wdform_5_state6\" name=\"wdform_8_state6\" value=\"\"  \/>                <label for=\"wdform_5_state6\" class=\"mini_label\">State \/ Province \/ Region<\/label><\/span><span class=\"wd-width-49 wd-address\" id=\"wdform_5_address_4\">              <input class=\"wd-width-100 wdform_5_address_4\" type=\"text\" id=\"wdform_5_postal6\" name=\"wdform_9_postal6\" value=\"\"  \/>              <label for=\"wdform_5_postal6\" class=\"mini_label\">Postal \/ Zip Code<\/label><\/span><span class=\"wd-width-49 wd-address\" id=\"wdform_5_address_5\">              <select class=\"wd-width-100 wdform_5_address_5\"                      type=\"text\"                      id=\"wdform_5_country6\"                      name=\"wdform_10_country6\"                      onchange=\"wd_change_state_input('wdform_5', '6')\"                      ><option value=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo\" >Congo<\/option><option value=\"Congo (Brazzaville)\" >Congo (Brazzaville)<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"Cote d'Ivoire\" >Cote d&#8217;Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Curacao\" >Curacao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"East Timor (Timor Timur\" >East Timor (Timor Timur)<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia, The\" >Gambia, The<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Korea, North\" >Korea, North<\/option><option value=\"Korea, South\" >Korea, South<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"North Macedonia\" >North Macedonia<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine\" >Palestine<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent\" >Saint Vincent<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\" >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Vatican City\" >Vatican City<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Wales\" >Wales<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select>              <label for=\"wdform_5_country6\" class=\"mini_label\">Country<\/label><\/span><\/span><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"86\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><center><h1 style=\"text-align: left;\" data-mce-style=\"text-align: left;\"><strong>Parent \/ Guardian Information<\/strong><\/h1><\/center><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"3\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_matrix\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_matrix\" ><div class=\"wdform-label-section wd-width-100 wdform_matrix wd-flex-row\">    <label  class=\"wdform-label\">PARENT\/CAREGIVER #1<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_matrix wd-flex-row wd-width-100\" ><div id=\"wdform_3_element6\" class=\"wd-width-100 wdform-matrix-table\" ><div class=\"wd-table-group\"><div class=\"wdform-matrix-head\"><div class=\"wd-table-cell\"><\/div><div><label class=\"wdform-ch-rad-label\">First Name<\/label><\/div><div><label class=\"wdform-ch-rad-label\">Surname<\/label><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"1\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" ><\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_3_input_element61_1\" type=\"text\" name=\"wdform_3_input_element61_1\" value=\"\" style=\"width:px\"><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_3_input_element61_2\" type=\"text\" name=\"wdform_3_input_element61_2\" value=\"\" style=\"width:px\"><\/div><\/div><\/div><input type=\"hidden\" name=\"wdform_3_element6\" value=\"\" \/><\/div><\/div><\/div><\/div><div wdid=\"77\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" value=\"\" id=\"wdform_77_element6\" name=\"h1\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"70\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_matrix\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_matrix\" ><div class=\"wdform-label-section wd-width-30 wd-hidden wdform_matrix wd-flex-row\">    <label  class=\"wdform-label\">PARENT\/CAREGIVER #1 CONTACT INFO<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_matrix wd-flex-row wd-width-100\" ><div id=\"wdform_70_element6\" class=\"wd-width-100 wdform-matrix-table\" ><div class=\"wd-table-group\"><div class=\"wdform-matrix-head\"><div class=\"wd-table-cell\"><\/div><div><label class=\"wdform-ch-rad-label\">Phone #<\/label><\/div><div><label class=\"wdform-ch-rad-label\">Email<\/label><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"1\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" ><\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_70_input_element61_1\" type=\"text\" name=\"wdform_70_input_element61_1\" value=\"\" style=\"width:px\"><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_70_input_element61_2\" type=\"text\" name=\"wdform_70_input_element61_2\" value=\"\" style=\"width:px\"><\/div><\/div><\/div><input type=\"hidden\" name=\"wdform_70_element6\" value=\"\" \/><\/div><\/div><\/div><\/div><div wdid=\"78\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" value=\"\" id=\"wdform_78_element6\" name=\"h2\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"71\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_matrix\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_matrix\" ><div class=\"wdform-label-section wd-width-100 wdform_matrix wd-flex-row\">    <label  class=\"wdform-label\">PARENT\/CAREGIVER #2<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_matrix wd-flex-row wd-width-100\" ><div id=\"wdform_71_element6\" class=\"wd-width-100 wdform-matrix-table\" ><div class=\"wd-table-group\"><div class=\"wdform-matrix-head\"><div class=\"wd-table-cell\"><\/div><div><label class=\"wdform-ch-rad-label\">First Name<\/label><\/div><div><label class=\"wdform-ch-rad-label\">Surname<\/label><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"1\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" ><\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_71_input_element61_1\" type=\"text\" name=\"wdform_71_input_element61_1\" value=\"\" style=\"width:px\"><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_71_input_element61_2\" type=\"text\" name=\"wdform_71_input_element61_2\" value=\"\" style=\"width:px\"><\/div><\/div><\/div><input type=\"hidden\" name=\"wdform_71_element6\" value=\"\" \/><\/div><\/div><\/div><\/div><div wdid=\"79\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" value=\"\" id=\"wdform_79_element6\" name=\"h3\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"72\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_matrix\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_matrix\" ><div class=\"wdform-label-section wd-width-30 wd-hidden wdform_matrix wd-flex-row\">    <label  class=\"wdform-label\">PARENT\/CAREGIVER #2 CONTACT INFO<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_matrix wd-flex-row wd-width-100\" ><div id=\"wdform_72_element6\" class=\"wd-width-100 wdform-matrix-table\" ><div class=\"wd-table-group\"><div class=\"wdform-matrix-head\"><div class=\"wd-table-cell\"><\/div><div><label class=\"wdform-ch-rad-label\">Phone #<\/label><\/div><div><label class=\"wdform-ch-rad-label\">Email<\/label><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"1\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" ><\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_72_input_element61_1\" type=\"text\" name=\"wdform_72_input_element61_1\" value=\"\" style=\"width:px\"><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_72_input_element61_2\" type=\"text\" name=\"wdform_72_input_element61_2\" value=\"\" style=\"width:px\"><\/div><\/div><\/div><input type=\"hidden\" name=\"wdform_72_element6\" value=\"\" \/><\/div><\/div><\/div><\/div><div wdid=\"80\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" value=\"\" id=\"wdform_80_element6\" name=\"h4\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"22\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><center><h1 style=\"text-align: left;\" data-mce-style=\"text-align: left;\"><strong>Student Media Release Consent<\/strong><\/h1><\/center><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"15\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><h2 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">Part 1 &#8211; Events<\/h2><p>I hereby agree and give my permission for the Mississauga Hellenic Academy (MHA), \u0395\u03bb\u03bb\u03b7\u03bd\u03b9\u03ba\u03cc \u03a3\u03c7\u03bf\u03bb\u03b5\u03af\u03bf \/ Greek School Program and\/or partners to record, film, photograph, audiotape or<br>videotape our\/my child\u2019s name, image, student work, and performance (hereinafter collectively referred to as \u201cWorks\u201d) and to display,<br>publish or distribute these Works for the purpose of publishing, posting on the website, posting in schools, posting on social media sites and\/or for broadcasting on television or radio as determined by the MHA Organizing Parent Committee.<\/p><p>I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive<br>any right to any royalties related to the use of these Works.<\/p><p>I understand that the Works may appear in electronic form on the internet or in other publications outside of the MHA\u2019s control.<br>I agree that I will not hold the MHA responsible for any harm that may arise from such unauthorized reproduction.<\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"16\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Events<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_16_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_16_element60\" name=\"wdform_16_element6\" value=\"AGREE\" onclick=\"set_default(&quot;wdform_16&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_16_element60\"><span><\/span>Please mark this box if you AGREE that your child may participate in recorded MHA school events and MHA hosted events as described above. (See Part 2 below) <\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_16_element61\" name=\"wdform_16_element6\" value=\"DISAGREE\" onclick=\"set_default(&quot;wdform_16&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_16_element61\"><span><\/span>Please mark this box if you DO NOT WISH your child to participate in recorded MHA\/school events and MHA hosted events. <\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"17\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><h2 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">Part 2 &#8211; Media Specific<\/h2><p>I also understand that external media organizations may attend school events. I give permission for our\/my child\u2019s name, image, student work, and performance to be photographed, filmed, audio-taped or videotaped for the purpose of being published and\/or broadcast on-line, on television or radio.<\/p><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"18\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Media Specific<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_18_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_18_element60\" name=\"wdform_18_element6\" value=\"AGREE\" onclick=\"set_default(&quot;wdform_18&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_18_element60\"><span><\/span>Please mark this box if you AGREE that your child may participate in media events that may be published or broadcast by organizations external to the MHA. <\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_18_element61\" name=\"wdform_18_element6\" value=\"DISAGREE\" onclick=\"set_default(&quot;wdform_18&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_18_element61\"><span><\/span>Please mark this box if you DO NOT WISH your child to be photographed, filmed, audio-taped or videotaped at media events. <\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"19\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row fm-type_radio\" ><div class=\"wdform-label-section wd-width-30 wd-hidden  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Understand content<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_19_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_19_element60\" name=\"wdform_19_element6\" value=\"YES\" onclick=\"set_default(&quot;wdform_19&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_19_element60\"><span><\/span>I have read this Student Media Release Consent Form and I fully understand the contents and meaning of this release. I understand that I am free to contact the Principal\/Site Supervisor with any questions regarding this release. <\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"24\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><center><h1 style=\"text-align: left;\" data-mce-style=\"text-align: left;\"><strong>Medical Information<\/strong><\/h1><\/center><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"26\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><h4 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">The collection and retention of the information requested on this form is authorized and governed by the Ontario Education Act and the Municipal Freedom of Information and Protection of Privacy Act. The following information will be helpful to the teacher in making your child\/ward comfortable and safe.<\/h4><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"32\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_name\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_name\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_32_element_title6\" class=\"wdform-label\">Family Physician&#8217;s Name<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" style=\"max-width: 500px;\"><div class=\"wd-flex wd-flex-column wd-width-10\"><input type=\"text\" id=\"wdform_32_element_title6\" name=\"wdform_32_element_title6\" value=\"Dr.\" title=\"Dr.\" placeholder=\"Dr.\" \/><label class=\"mini_label\" for=\"wdform_32_element_title6\">Title<\/label><\/div><div class=\"wd-flex wd-flex-column wd-name-separator\"><\/div><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_32_element_first6\" name=\"wdform_32_element_first6\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_32_element_first6\">First<\/label><\/div><div class=\"wd-flex wd-flex-column wd-name-separator\"><\/div><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_32_element_last6\" name=\"wdform_32_element_last6\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_32_element_last6\">Last<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"33\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_phone_new\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_phone_new\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_33_element6\" class=\"wdform-label\">Family Physician&#8217;s Phone Number<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                       class=\"wd-width-100\"                       id=\"wdform_33_element6\"                       name=\"wdform_33_element6\"                       value=\"\"                       placeholder=\"\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"65\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_65_element6\" class=\"wdform-label\">Ontario Health Card #<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 500px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_65_element6\"                           name=\"wdform_65_element6\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"34\" class=\"wdform_row\"><div type=\"type_checkbox\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_checkbox\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Medical Conditions:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_34_element6\" value=\"\" \/><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element60\" name=\"wdform_34_element60\" value=\"Diabetes\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element60\"><span><\/span>Diabetes<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element61\" name=\"wdform_34_element61\" value=\"Digestive upsets\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element61\"><span><\/span>Digestive upsets<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element62\" name=\"wdform_34_element62\" value=\"Ear, nose, throat infection\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element62\"><span><\/span>Ear, nose, throat infection<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element63\" name=\"wdform_34_element63\" value=\"Dislocated shoulder, swollen\/painful joints, joint disability\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element63\"><span><\/span>Dislocated shoulder, swollen\/painful joints, joint disability<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element64\" name=\"wdform_34_element64\" value=\"Fainting spells\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element64\"><span><\/span>Fainting spells<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element65\" name=\"wdform_34_element65\" value=\"Feet or leg problems\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element65\"><span><\/span>Feet or leg problems<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element66\" name=\"wdform_34_element66\" value=\"Hemophilia\/bleeding disorders\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element66\"><span><\/span>Hemophilia\/bleeding disorders<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element67\" name=\"wdform_34_element67\" value=\"Heart problems\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element67\"><span><\/span>Heart problems<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element68\" name=\"wdform_34_element68\" value=\"Hernia(s)\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element68\"><span><\/span>Hernia(s)<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element69\" name=\"wdform_34_element69\" value=\"Current or history of head injuries\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element69\"><span><\/span>Current or history of head injuries<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element610\" name=\"wdform_34_element610\" value=\"Migrane\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element610\"><span><\/span>Migrane<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element611\" name=\"wdform_34_element611\" value=\"Rash\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element611\"><span><\/span>Rash<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element612\" name=\"wdform_34_element612\" value=\"Recent illness or operation\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element612\"><span><\/span>Recent illness or operation<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element613\" name=\"wdform_34_element613\" value=\"Rheumatic fever\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element613\"><span><\/span>Rheumatic fever<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element614\" name=\"wdform_34_element614\" value=\"Seizures\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element614\"><span><\/span>Seizures<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element615\" name=\"wdform_34_element615\" value=\"Sleepwalking\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element615\"><span><\/span>Sleepwalking<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element616\" name=\"wdform_34_element616\" value=\"Urinary infections\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element616\"><span><\/span>Urinary infections<\/label><\/div><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_34_element617\" name=\"wdform_34_element617\" value=\"Other\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element617\"><span><\/span>Other<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"38\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_38_element6\" class=\"wdform-label\">If other is checked, list the condition(s) here<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_38_element6\"                      name=\"wdform_38_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"35\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_35_element6\" class=\"wdform-label\">Please provide details of usual treatment for each of the conditions indicated<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_35_element6\"                      name=\"wdform_35_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><div wdid=\"36\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_36_element6\" class=\"wdform-label\">Please explain if your child\/ward has any medical condition that requires any modification of his\/her program<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_36_element6\"                      name=\"wdform_36_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"39\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><h3 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">PLEASE LIST ALL KNOWN ALLERGIES TO THE FOLLOWING:<\/h3><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"40\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_40_element6\" class=\"wdform-label\">Food Allergies<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_40_element6\"                      name=\"wdform_40_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><div wdid=\"43\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_43_element6\" class=\"wdform-label\">If foods are life-threatening, please explain the symptoms and the treatment:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_43_element6\"                      name=\"wdform_43_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"41\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_41_element6\" class=\"wdform-label\">Medication Allergies<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_41_element6\"                      name=\"wdform_41_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"42\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_42_element6\" class=\"wdform-label\">Other Allergies (e.g., bee or wasp stings, environmental allergies)<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_42_element6\"                      name=\"wdform_42_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"44\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Has your child suffered any serious allergic or asthmatic reaction? <\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_44_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_44_element60\" name=\"wdform_44_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_44&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_44_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_44_element61\" name=\"wdform_44_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_44&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_44_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"45\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_45_element6\" class=\"wdform-label\">If so, please provide details, including the type and severity of reaction:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_45_element6\"                      name=\"wdform_45_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"46\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Has a doctor prescribed an Epi-Pen for your child?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_46_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element60\" name=\"wdform_46_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element61\" name=\"wdform_46_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"47\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Has a doctor prescribed an inhaler for asthma?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_47_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_47_element60\" name=\"wdform_47_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_47&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_47_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_47_element61\" name=\"wdform_47_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_47&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_47_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"48\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Has a doctor prescribed an inhaler for any other reason?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_48_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_48_element60\" name=\"wdform_48_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_48&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_48_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_48_element61\" name=\"wdform_48_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_48&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_48_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"50\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><h3 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">DIETARY RESTRICTIONS<\/h3><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"51\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_51_element6\" class=\"wdform-label\">Please list any foods your child should not eat for medical, dietary, or religious reasons<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_51_element6\"                      name=\"wdform_51_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"52\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><h3 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">MEDICATION<\/h3><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"53\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Does your child\/ward take prescribed medication on a regular basis?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_53_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_53_element60\" name=\"wdform_53_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_53&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_53_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_53_element61\" name=\"wdform_53_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_53&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_53_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"54\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_54_element6\" class=\"wdform-label\">If yes, please specify<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_54_element6\"                      name=\"wdform_54_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"55\" class=\"wdform_row\"><div type=\"type_editor\" class=\"wdform-field\"><h3 style=\"text-align: left;\" data-mce-style=\"text-align: left;\">GENERAL<\/h3><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"56\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\"> Does your child wear or carry medical alert identification (e.g., bracelet)?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_56_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_56_element60\" name=\"wdform_56_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_56&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_56_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_56_element61\" name=\"wdform_56_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_56&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_56_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"57\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_57_element6\" class=\"wdform-label\">If yes, please specify what is written on it<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_57_element6\"                      name=\"wdform_57_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"58\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Does your child have any other relevant medical condition that will require modification of the program?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_58_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_58_element60\" name=\"wdform_58_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_58&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_58_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_58_element61\" name=\"wdform_58_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_58&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_58_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"59\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_59_element6\" class=\"wdform-label\">If yes, please explain<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_59_element6\"                      name=\"wdform_59_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"60\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\"> Does your child have any special fears or conditions (e.g., anxiety, bed-wetting, and nightmares), the knowledge of which will allow the teacher to make the student more relaxed?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_60_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_60_element60\" name=\"wdform_60_element6\" value=\"Yes\" onclick=\"set_default(&quot;wdform_60&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_60_element60\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_60_element61\" name=\"wdform_60_element6\" value=\"No\" onclick=\"set_default(&quot;wdform_60&quot;,&quot;1&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_60_element61\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"61\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_61_element6\" class=\"wdform-label\">If so, please explain<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_61_element6\"                      name=\"wdform_61_element6\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"62\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Should it become necessary for my child\/ward to have medical care, I hereby give the MHA teacher permission to use her\/his best judgment in obtaining the best of such service for my child. I also understand that in the event of such illness or accident, I will be notified as soon as possible.<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_62_element6\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_62_element60\" name=\"wdform_62_element6\" value=\"I consent\" onclick=\"set_default(&quot;wdform_62&quot;,&quot;0&quot;,&quot;6&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element60\"><span><\/span>I consent<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"1\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_submit_reset\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_submit_reset\" ><div class=\"wdform-element-section wd-flex  wd-flex-row wd-justify-content-left wd-width-100\" ><button  type=\"button\" class=\"button-submit\" onclick=\"fm_submit_form('6');\"  data-ajax=\"0\"><span class=\"fm-submit-loading spinner fm-ico-spinner\"><\/span>Submit<\/button><button  type=\"button\" class=\"button-reset wd-hidden\" onclick=\"fm_reset_form(6);\" >Reset<\/button><\/div><\/div><\/div><\/div><\/div><div valign=\"top\" class=\"wdform_footer wd-width-100\"><div class=\"wd-width-100\"><div class=\"wd-width-100 wd-table\" style=\"padding-top:10px;\"><div class=\"wd-table-group\"><div id=\"6page_nav1\" class=\"wd-table-row\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_preload\"><\/div><\/form><\/div><\/div>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Registration PLEASE NOTE : The MHA program is now full for this 2023-24 school year. If you would like to register your child(ren), please note that their name(s) will be placed on a waiting list should space become available. Please complete the registration form only at this time; do not make payment. Thank you.<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/page-builder.php","meta":[],"_links":{"self":[{"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/pages\/533"}],"collection":[{"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/comments?post=533"}],"version-history":[{"count":155,"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/pages\/533\/revisions"}],"predecessor-version":[{"id":1244,"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/pages\/533\/revisions\/1244"}],"wp:attachment":[{"href":"https:\/\/hellenicacademy.ca\/index.php\/wp-json\/wp\/v2\/media?parent=533"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}