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After School Program Registration Form
Virtual Reality Programs
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Email
*
Your email
Description of Programs
Longview School
This program is made possible by a generous grant from the Vela Education Fund.
Student Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade (during the 2021-22 School Year--these programs are for 5th to 10th graders)
*
Your answer
Parent Name
*
Your answer
Parent Email Address
*
Your answer
Parent Mobile Phone
*
Your answer
Home Address--Street
*
Your answer
Home Address--City, State, Zip Code
*
Your answer
Program(s) Registering For (Register for 1 class)
*
Virtual Reality Class on Tuesdays (4/19, 4/26, 5/3, 5/10, 5/17, 5/24, 5/31)
Virtual Reality Class on Thursdays (4/21, 4/28, 5/5, 5/12, 5/19, 5/26, 6/2)
Required
What COVID vaccination level does your child have?
*
1st Dose
2nd Dose
Booster
Non-vaccinated
Required
I understand and agree that if my child presents COVID symptoms or if my child is unvaccinated, they may be rapid tested at the program.
*
Yes
No
I understand and agree that masks may be required while at Longview School.
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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