AFTER SCHOOL ACADEMY OF EXCELLENCE

Register Today!

Student Name

First Name

Last Name

Students Date of Birth

YYYY

Students Current Grade

Name of Student’s School, City and State

The standard rate is $50 per week. If the student needs school pick up and/or home drop off, the cost is $60 per week

Does the student need transportation from school? Yes or No.

Does the student need transportation home after the Academy of Excellence? Yes or No.

Parent or Guardian Name

First Name

Last Name

Parent or Guardian’s Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent or Guardians Home Number

(###)

###

####

Parent or Guardians Cell Number for Text Alerts

(###)

###

####

Parent or Guardian’s Email Address

Please indicate specific subjects challenging your student’s academic success. VGA will add emphasis on the indicated subject area(s).

VGA will offer snacks. Does the student have any known food allergies? (yes or no)

If yes, please identify

Type "N/A" if not applicable.

Media Release: Do you consent to VGA taking pictures and/ or using your child’s image for student highlights and/or VGA promotions? Yes or No

Signature of Parent or Guardian

I Consent To Registration

I Do Not Consent To Registration, Cancel My Request.