Welcome to Town & Village! We are glad you are here! Please fill out the information below to help us get to know you and your students. If at any point you need assistance or have questions, feel free to give us a call at 859-987-4980 or email at

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Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Contact #2
How can we contact you?
(Emails are kept confidential)
Student #1
Additional Info
Enroll in Classes
Select Class
Required Policies and Agreements
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I Agree to All of the Above
Questions or Concerns
Payment Information
Credit Card