The Avalon Village Online Registration

Welcome to The Homework House at Avalon Village! We're excited to have you join our family. Please complete the following registration form for your family. You'll be able to add each child under one (1) family account. Each family is responsible for a $25 Annual Registration fee that will be automatically added to your parent portal. If you have any questions, please contact our team directly at saidah@theavalonvillage.or

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation*

Disabilities (Type NONE if none)*

Special Needs (Type NONE if none)*

Allergies (Type NONE if none)*

Medications (Type NONE if none)*

Primary Doctor

Immunizations YN

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation*

Disabilities (Type NONE if none)*

Special Needs (Type NONE if none)*

Allergies (Type NONE if none)*

Medications (Type NONE if none)*

Primary Doctor

Immunizations YN

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation*

Disabilities (Type NONE if none)*

Special Needs (Type NONE if none)*

Allergies (Type NONE if none)*

Medications (Type NONE if none)*

Primary Doctor

Immunizations YN

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation*

Disabilities (Type NONE if none)*

Special Needs (Type NONE if none)*

Allergies (Type NONE if none)*

Medications (Type NONE if none)*

Primary Doctor

Immunizations YN

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation*

Disabilities (Type NONE if none)*

Special Needs (Type NONE if none)*

Allergies (Type NONE if none)*

Medications (Type NONE if none)*

Primary Doctor

Immunizations YN

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Student #2 (Show-Hide Details)

Additional Info

Student #3 (Show-Hide Details)

Additional Info

Student #4 (Show-Hide Details)

Additional Info

Student #5 (Show-Hide Details)

Additional Info

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Required Policies

(Show-Hide Details)