Your email address:
Your name:
Your phone number:
First Child's Information:
Your child's birthdate:
Your child's name:
Your child's school
Club Selection
Club Selection
Please use this space to
inform us of any medical
conditions or allergies
that your child may have.
Second Child's Information:
Your child's birthdate:
Your child's name:
Your child's school
Club Selection
Club Selection
Please use this space to
inform us of any medical
conditions or allergies
that your child may have.
Please enter 2 other people below as emergency contacts. Names & phone
numbers are all that are required.
8 week Session - January 22nd - March 11th
Clubs meet every Tuesday
Spanish 2:30, 3:30 or 4:30
Chess 2:30, 3:30 or 4:30
Musical Keyboarding 3:30 & 4:30
A confirmation & invoice will be sent via email.
Click here to review
Vinings Academy Policies
By clicking the submit button, you certify that
you have read and agree to the policies of
Vinings Academy.
For additional children submit another form!
Vinings Academy
C
lub Family registration