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Family Registration Form
*
Indicates required field
Parent/Guardian Name
*
First
Last
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Student Name
*
First
Last
Email
*
City/State
*
Parent Number
*
Payment will be required
*
I Understand Completely
Villlage Konnect LLC charges $300.00 per household for the 3 month program. You may pay $100.00 monthly if needed. Please check if this is understood.
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
Home
Services
VK Community Podcast
Season 1
Season 2
Season 3
Village Konnects Apparel
About
Contact