Clone of Course Registration Form

2026-2027 Valiente Dual Academy Registration Form
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Courses
Check (Valiente Dual Academy)Credit CardPayPalEMA Step-Up
Please let us know if your student needs extra support or accommodations or has any severe allergies or conditions we need to be aware of.
Tuesday 3:15 PM FWBThursday 3:15 PM FWBMonday 3:15 PM VALPWednesday 3:15 PM VALP
Should be Empty:

2026-2027 Valiente Dual Academy Registration Form