Virtual Learners Aftercare Registration Form
Please fill out the following form to sign up your child for any VLA classes
Email address *
Parent's Name: *
Parent's Phone Number: *
Child's Name: *
Child's Birthday: *
How old is your child? *
What grade is your child in? *
Is there anything you would like to share about your child that would assist in their learning experience? *
Where will you be joining our program from? (City, State)
What session(s) are you interested in? *
What days will your child be attending the group session? *
Notes (if you would like a combination of sessions and 1:1 tutoring please detail days and times below) *
What payment package would you like to go with? *
How did you hear about us? *
By clicking the below box I acknowledge that I will be sent an email to the email given about and that email will be where I submit payment for the program(s) that I have requested. *
By clicking the below box I acknowledge that there will be no classes on the following days: Nov 11th (Veterans Day), Nov 26 & 27th (Thanksgiving), Dec 10th, Dec 24 & 25 (Christmas), and Dec 31 & Jan 1 (New Years). *
By clicking the below box I acknowledge that I have read and agree to the terms and policies in the VLA handbook posted on the website. *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Virtual Learners Aftercare.