Enrollment

Enrollment

Kindly submit the required information in the online form. Valley View Learning Center hopes to have your child in one of our classes and play groups soon.

* = Required Information

Child's Information

Child's Full Name *

Birth Date *

Age *

Sex *
MaleFemale

Parent/Guardian's Information

Parent/Guardian's Name *

Address *

City *

State *

Email Address *

Phone*

Person to Contact in Case of Emergency if Parent/Guardian Cannot be Reached

Name *

Address *

Health Information

Name of Child's Doctor *

Phone *

Hospital Preference *

Please list down any allergies or dietary restrictions of the child *

Additional Information

Contact Information

Event here

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