After School Enrollment Form

Victory Learning Academy II Pre-Registration

We are so excited to have you join us at VLA II. Once you have completed your registration, a member of our team will reach out to you to discuss the next steps to get you started! Please complete 1 form per child.
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Level*
Sibling attending?*

YesNo
Siblings Names*
Please enter the name of all children that also have a form completed for attendance. If child does not have a sibling attending please enter N/A in the box.
School

SELECT THE SCHOOL/S THAT APPLY
Please Select Your Child's School

Fairview Elementary SchoolD.S Johnson Elementary SchoolWinstead Elementary SchoolBenevenue Elementary SchoolEnglewood Elementary SchoolBullock Elementary SchoolParker Middle SchoolEdwards Elementary SchooRocky Mount Middle SchoolWest Edgecombe Middle SchoolBaskerville Elementary SchoolWilliford Elementary SchoolM.B Hubbard Elementary SchoolCoopers Elementary School
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Should be Empty:

Victory Learning Academy II Pre-Registration