Use this form for a New Registration or for Updating Current Enrollment Files
**Fill in ALL required spaces. Write "None or N/A" for anything that does not apply.

Click here to download and and print the Child Registration Form. 

Completed forms can be submitted using the following secure methods:

1. Email to us at

2. Fax to 804-980-7016

3. Bring it with you when you visit 

$60.00 Deposit Hold


~Will be applied to your registration fee at the time of enrollment

Deposit Hold Fee can also be sent by using CashApp to $A1Provider

You can download Cash App by clicking this link CASHAPP and they will pay both of us $5. This is the easiest Activity and Fieldtrip fundraiser we have found and we appreciate you for using this link.

To learn more about Cash App CLICK HERE.