James Valley Christian School K-6 New Student Enrollment Application

James Valley Christian School K-6 New Student Enrollment Application

2022-23 School Year
Student's Full Name *
First, Middle, Last
Please select which grade the student will be entering. *
Student's Birthday *
Student's Gender *

Male Female
Student's Ethnicity (Check all that apply.)

Hispanic/Latino Asian White African American American Indian Other
Address *

Street Address

Street Address Line 2

City State / Province

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

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

Yes No
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? *

Yes No
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? *

yes no
If yes, please explain.
Does the applicant wear corrective lenses? *

yes no
Has the applicant had a history of ear infections or hearing difficulties? *

yes no
Does your child have any allergies or medical conditions? *

yes no
If yes, please explain the allergy or condition and treatment.
Permission is granted to administer ibuprofen or acetaminophen as needed. *

Yes No
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 15 12 monthly payments starting August 15 Two payments: August 15 and January 15 Total payment at the start of the school year
There is a nonrefundable fee of $165 due with this application. *
prev next ( X )
Application Fee
$ 165.00

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 *

Month Day Year
Date
Please click yes if you WILL give permission for us to take photos of your child for website and social media use. *

Yes No
How did you find us?

Sign Flyer Google/Other search engine Facebook or Instagram Friend Other
If you were referred by a friend please let us know who, so we can thank them!
Should be Empty: