Registration Form

Student Information
Student Name *
Student Name
(For private schools, just list the school's name again here.)
Address *
Cell Phone *
Cell Phone
Home Phone *
Home Phone
If you answered yes to any of the above questions, please note any modifications the student receives.
Parent Information
Parent Name *
Parent Name
Parent Cell Phone *
Parent Cell Phone
Parent Home Phone *
Parent Home Phone
If yes, check the phone(s) that you would like to receive text messages.
Course Information
First Course Credits
Second Course Credits
Third Course Credits
Fourth Course Credits
Fifth Course Credits
Type of Course
Semester for Enrollment *
Please indicate the semester in which you desire to enroll.
School approval is required for registration. In this box, please give the contact information for the person at your school who will grant approval of the course. This could be a school counselor or principal. Please include contact information such as an email or phone number.
Choose an option . . .

Don't hesitate to call or email us if you need assistance requesting an online course. 

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Students who are already registered with Village Virtual may request additional courses by email, phone or text.

Privacy Policy:  Village Virtual never shares the information of its clients or their families and adheres to all state and federal policies regarding the use of student data.


Phone or Text