Virtual Learning Center Registration Form
The Virtual Learning Center (VLC) is now OPEN!!!

​Please complete each section of the VLC registration form.

We are excited to offer children inside and outside of the community a safe and secure place. Providing a place where children can not only continue to grow academically but socially. While adhering to the Covid-19 rules and regulations, the VLC allows children to be around their peers at a safe distance.

​Due to restrictions with the number of persons in the facility registration is required. 

We ask that you bring your child's assigned electronics to connect to our FREE WIFI. If you currently do not have a school assigned electronic or home computer please be sure to note that on the registration form. 

If your child has any allergies or special requirements please also note that in the additional information section. Safety is our number one concern. 

We look forward to seeing you on Mondays and Wednesdays at the VLC!!!

Please use all LEGAL NAMES (as shown on identification), as we will NOT release the child to anyone who does NOT have identification.

Email address *
Parent's / Guardians Full Name *
Parent's / Guardians Phone Number *
Parent's / Guardians Full Address, city, state, and zip code *
Child's Full address, city, state, and zip code (if the child does not reside with the parents if it is the same list "same") *
Emergency Contact's First and Last Name *
Emergency Contact's Phone number (format xxx-xxx-xxxx) *
Child/Children's Names and DOB mm/dd/yyyy *
Child/Children's Allergies/Special Needs: Please list their name - allergies and/or special need(s) *
How will your child arrive and leave from the Virtual Learning Center? (select the one that applies) *
Do we have your permission in the event of an emergency to contact 911 or transport your child(ren) to an emergency facility? (You and your emergency contact will also be notified) *
List the person(s) the child(ren) are able to be released to and their phone number. Please list them in priority order. (format xxx-xxx-xxxx) *
By checking the box below, you are adhering to all of the rules and regulations of the After Christ Christian Center and the VLC program. You are acknowledging that everything listed above is correct and true to the best of your knowledge. Also by clicking (signing) below, you are releasing any and all liability of the After Christ Christian Center, it's members, volunteers, and anyone assisting with the program of any liability that the child(ren) may incur including the personal devices. *
A copy of your responses will be emailed to the address you provided.
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