Family Registration

Family Registration Form

* Indicates required field

Parent/Guardian Name *

First

Last

Student Name *

First

Last

Email *

City/State *

Parent Number *

Payment will be required *

I Understand Completely

When this form is completed filled out and submitted, a Village Konnect representative will reach out to you to initiate the process. Thank you for considering our programs.

Gender *

Male Female Other

Grade *

Middle School 6-8 High School 9-10

Please Check All that Apply *

Interested in Family Mentoring Program Computer Access with Internet Access More than 1 child will be attending

Submit