Name *

First Name

Last Name

I acknowledge that there are specific requirements for receiving Free Monthly VR Session Vouchers. *

Yes

I read and understood the requirements for being eligible for Free Monthly VR Session Vouchers.

Yes

I certify that my child is older than 7 and younger than 18. (only children ages 8-17 qualify for free VR Sessions) *

Yes

I have uploaded one of the required documents proving that my child qualifies for Free VR Sessions. *

yes