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	The VIA School 1414 Westwood Road Charlottesville, Virginia 22903		PTO & Staff Registration
User Name*		*Minimum six characters
Password *		* Please use a combination of alpha and numeric or special characters
Confirm Password
Name		First:		Last:
Email
Address
City		State: Zip Code:
Telephone		Home: Cell: Work:
Does your child attend VIA? Yes No If "Yes" please add your child/children's name/s and what Module they are assigned. Name: Module: Name: Module: Are you an instructor or staff member at VIA? Yes No If "Yes" which Module or Area are you assigned?