Valley Christian Heritage School
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Enrollment Form (Preschool-Kindergarten)
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Indicates required field
Student Last Name
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Student Middle Name/Initial
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Student First Name
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SOCIAL/SCHOLASTIC/DISCIPLINARY INFORMATION:
Is speech normal?
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Yes
No
Is sight normal?
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Yes
No
Is hearing normal?
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Yes
No
Any medical problem?
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Yes
No
Ever enrolled in tutoring?
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Yes
No
Ever enrolled in special education?
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Yes
No
Ever have any academic problems?
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Yes
No
Ever have any discipline problems?
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Yes
No
Explain any "Yes" answers.
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Has student EVER had any kind of law violations or juvenile record?
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Yes
No
Academic grade level of previous school year's work
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What kind of grades does student normally make (choose one or two)?
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A
B
C
D
F
Has student ever been suspended?
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Yes
No
Has student ever been dismissed?
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Yes
No
Has student ever been expelled?
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Yes
No
Has student ever been refused admission to any school?
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Yes
No
Does student have behavioral problems at home?
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Yes
No
Has student ever used tobacco of any kind?
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Yes
No
Has student ever used liquor of any kind?
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Yes
No
Has student ever used non-prescribed drugs of any kind?
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Yes
No
Are there any kind of family, personal, or former-experience problems that might affect or influence student's attitude or behavior?
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Yes
No
Does student have any kind of allergies?
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Yes
No
List allergies
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Does student have any kind of special needs?
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Yes
No
List special needs
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Give the details of any "Yes" answers.
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(All of this information will be kept confidential, but it is extremely important that we be advised in order to be able to optimize our assisting each student.)
Student's special interests/hobbies?
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List extracurricular activities of interest.
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Is parent/guardian able/willing to assist with extracurricular activities, coaching, etc.?
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Yes
No
GENERAL, WAIVER FOR TRANSPORTATION (FIELD TRIPS, ATHLETIC EVENTS, ETC.)
My child has my permission to go on any and all trips and to participate in any and all activities, along with other children from Valley Christian Heritage School, Inc., during his/her entire enrollment in the school. In consideration of my child being permitted to make such trips and take part in such activities and the instruction each child will receive by reason thereof, I hereby release VCHS, its trustees, officers, administrators, faculty, and/or staff members, together with any volunteer carrier of such child without compensation, from any and all liability and responsibility in connection with such trips and activities, and hereby release all of said parties from all liability by reason of any accident or injury suffered by said child while on said trips or engaged in such activities. I further assume all responsibility for my child's actions and all behavior on such trips and activities.
Full Name of Mother or Guardian in Lieu of Signature
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Full Name of Father or Guardian in Lieu of Signature (if none state None)
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Date Signed
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NOTE: No child will be allowed to participate in any of the above-mentioned activities and/or trips unless the above form is completed. The form will be kept on file as required by state law. Notification will be given before ANY trips are taken; an additional permit stating approval or attendance for each specific trip is to be signed and returned to the school prior to each activity. However, if a child forgets the permit, he/she will be allowed to go, and THIS form (on file) will serve for information.
TRANSPORTATION:
Specify if student is to travel to school by any of these means.
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Walk
Ride a bike
Drive a car
Driver's license number of student with parental permission to drive:
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(Student who drives vehicle to campus must park in designated area and must take keys to the office upon arrival. Keys will be left in the office until school is out each day. Students are NOT allowed to go to their cars during the school day.)
CHILD FINGERPRINTS (for Child Find):
You may attach a photo or pdf print of each finger of your child or they will be taken at school. This MUST be a photo or pdf of the print and not the finger.
Left little finger
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Max file size: 20MB
Left ring finger
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Max file size: 20MB
Left middle finger
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Max file size: 20MB
Left index finger
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Max file size: 20MB
Left thumb
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Max file size: 20MB
Right thumb
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Max file size: 20MB
Right index finger
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Max file size: 20MB
Right middle finger
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Max file size: 20MB
Right ring finger
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Max file size: 20MB
Right little finger
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Max file size: 20MB
Submit
Home
About Us
Our Mission
Our Faculty
Contact Us
Privacy Policy
Curriculum
Enrollment
Testimonials
Sponsors
Photos
News about VCHS