The Village Tutorial and Enrichment Program After Care Extended Programming

The Village Tutorial and Enrichment Program Registration Form
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Expected Start Date

MonthDayYear
Date
Expected Departure Date

MonthDayYear
Date
School Attending blanks .
Grade Attending
Attendance Schedule Choice
Which program are you wanting to register for?
Student Information
First Name
Last Name
Gender
Birth Date

MonthDayYear
Home Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Health Care #
Doctors Name

First NameLast Name
Doctors Phone Number
Format: (000) 000-0000.
Parent/Guardian Information 1
Full Name

First NameLast Name
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail
example@example.com
Address - Same As Child
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 2
Full Name

First NameLast Name
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail
example@example.com
Address - Same As Childs
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Infomation
Is your child immunized?
Does your child have any allergies?
If yes please list, including any food or drug allergies.
Does your child have any medical conditions?
Does your child require any medication? If yes, please list these medications.
Do you authorize us to administer the medications listed above?
Please list the people authorized to pick up your child. Please be prepared to show proper identification.
Does your child have any siblings?
If yes, what is their age(s)?
Comments
Emergency Contact - Other than Parent/Guardian
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Signature
The registration fee to participate in our program is $25.00 per child. This fee will be applied to the first program selection weekly fee.

Spring Break Camp 2024 fees are $125.00 per week. Lunch and snack are provided. Lunch will need advanced meal registration. A culminating field trip is included in the camp fee.

Summer Camp 2024 fees are $275.00 per week. Early bird savings will be $225.00, per week, with full summer tuition paid by April 1, 2024. Payments can be made in installments for February 1, 2024, March 1, 2024, and April 1, 2024. A sibling discount of 10% is applicable for families with the Early Bird savings and regular rate. Camp fees include field trips and daily snacks. A lunch meal schedule will be provided for families with interest.

The weekly tuition for The Village Tutorial and Enrichment Program after school service is $125.00, per child, that includes snack, reading or math tutoring and core content enrichment with S.T.E.M. activities. Dinner will be added with family interest. All fees are due on Monday of each week. There is a late fee of $25.00 for unpaid fees. Students are not permitted to attend after one week attending without payment.

We look forward to serving you and creating moments to remember.
Program Services Payment (Please identify program registered.)

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The Village Tutorial and Enrichment Program Registration Form

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian

Program Services Payment (Please identify program registered.)

Payment Methods