James Valley Christian School K-6 New Student Enrollment Application

James Valley Christian School K-6 New Student Enrollment Application

2023-24 School Year
Student's Full Name*
First, Middle, Last
Please select which grade the student will be entering.*
Student's Birthday*
Student's Gender*

MaleFemale
Student's Ethnicity (Check all that apply.)

Hispanic/LatinoAsianWhiteAfrican AmericanAmerican IndianOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
With whom does the child live?*

Both ParentsMotherFatherOther
Father's Name*
Email Address*
Phone Number*
Do you receive texts at this number?*

YesNo
Cell Phone Carrier*
Required in order to receive texts when school is cancelled or starts late.
Mother's Name*
Email Address*
Phone Number*
Do you receive texts at this number?*

YesNo
Cell Phone Carrier*
Required in order to receive texts when school is cancelled or starts late.
Emergency Contact*
Other than parents.
Phone Number*
Please list the names, dates of attendance, and addresses of schools attended other than JVCS.*
What church are you affiliated with?
Has your child made a profession of salvation? If yes, please tell about this experience.*
Why do you desire to have your child attend JVCS?*
Please list names and ages of siblings.
Has this student received any special education services such as help with speech or learning disabilities?*

yesno
If yes, please explain.
Does the applicant wear corrective lenses?*

yesno
Has the applicant had a history of ear infections or hearing difficulties?*

yesno
Does your child have any allergies or medical conditions?*

yesno
If yes, please explain the allergy or condition and treatment.
Permission is granted to administer ibuprofen or acetaminophen as needed.*

YesNo
South Dakota law states that you must have immunization. If you were vaccinated in SD, our office will access those records from the state database. If you were vaccinated out of state, please provide our office with proper certification.*

Student was vaccinated in South Dakota.Student was vaccinated out of state.Student has an exemption. I will complete the necessary paperwork at the school office.
Tuition Payment Plan - Please indicate the method you will use to pay your tuition. Note: Our tuition rates are set just under 50% of the actual cost of educating your child. The difference is made up through fundraisers and donations. If you feel you have additional needs, please use the "Partners in Education" link on our website to begin the financial aid process.*

10 monthly payments starting August 1512 monthly payments starting in JulyTwo payments: August 15 and January 15Total payment at the start of the school year
There is a nonrefundable fee of $175 due with this application.*
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Application Fee
$175.00

Total

$0.00
While it is difficult to arrive at community values with which we all agree, we ask you to abide by the standards that have been set forth by the administration, faculty, and governing board of our school. It is our prayer that we as a school will maintain a good witness and testimony while working in harmony with one another.
Father's E-Signature*

Clear
Mother's E-Signature*

Clear
Today's Date*

MonthDayYear
Date
Please click yes if you WILL give permission for us to take photos of your child for website and social media use. We will continue to use the preference indicated in upcoming school years unless you contact us.*

YesNo
Each year we print a JVCS Family Directory. Every student, family, staff member and executive committee member is listed in this directory. Please check your preferences below. We will continue to use the preference indicated in upcoming school years unless you contact us.*

Yes, please include our contact information in the directory.Please do not include our phone number.Please do not include our address.Please do not include our email address.
How did you find us?

SignFlyerGoogle/Other search engineFacebook or InstagramFriendOther
If you were referred by a friend please let us know who, so we can thank them!
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