Valley Harvest Ministries - VHCS Application

Valley Harvest Christian School

Student Application

Prior to completing your application, you may go ahead and pay the application fee(s) by clicking one of the following options:

IMPORTANT REMINDER: An separate application will need to be completed for each child you would like considered for enrollment.

Having trouble submitting the electronic application? Print the PDF to complete and mail!

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Student Information

First and Middle Name

Last Name

Mailing Address

City/State/Zip Code

Age

Sex
Male
Female

Birth Date

Birthplace

School Last Attended

School's Address

Last Grade Completed

Family Information

Best Email to Reach Parents

Father's Name

Phone Number

Employer and Position Title

Mother's Name

Phone Number

Employer and Position Title

Emergency Contact (if a parent cannot be reached)

Emergency Contact Phone Number

Relationship to the applicant

Name(s)/Age(s) of children in the family of school age (if not also applying for the school)

Reason they are not applying

Religious Information

Church attending

Address

Pastor

Pastor/Church Phone Number

Is the student's father a Christian?
Yes
No

Is the student's mother a Christian?
Yes
No

Has the applicant ever made a profession of faith in Christ?
Yes
No

Medical Information

Applicant's Physician

Phone Number

Does the applicant have any physical restrictions or allergies?
Yes
No

If yes, please explain:

Has the applicant received any of the following immunizations?
DTP/DTaP/TD/Td
Polio
MMR
Varicella
Hepatitis B

Scholastic Information

Has the applicant ever been expelled, suspended, or been refused admission to another school?
Yes
No

If yes, please explain:

Has the applicant ever had disciplinary difficulty at school?
Yes
No

If yes, please explain:

Does the applicant have a juvenile or arrest record?
Yes
No

If yes, please explain:

Has the applicant ever used tobacco or nonprescription drugs of any kind?
Yes
No

If yes, please explain:

Please indicate the academic level of the applicant's previous work
Excellent
Good
Average
Poor

Has the applicant ever failed an academic subject in school?
Yes
No

If yes, please explain:

General Information

How did you hear about our school?

Reason for selecting our school:

Did you pay the application fee online?
Yes
No

If not, how do you plan to pay?
Check/cash in person at the church/school (1 Harvest Place, Dublin, VA 24084)
Check/cash via mail (P.O. Box 458, Dublin, VA 24084)

The application must be filled out completely before it will be processed. The application fee must accompany the application and is non-refundable. An interview with the parents and the applicant will be required before final acceptance.

I hereby verify that I have read the instructions and requirements for the application and acceptance process to Valley Harvest Christian School. I agree that this application may be electronically signed. I agree that the electronic signature appearing on this agreement is the same as my handwritten signature for the purposes of validity, enforceability, and admissibility. Please type your full, legal name here.

Submit

Valley Harvest Christian School

Student Application

Prior to completing your application, you may go ahead and pay the application fee(s) by clicking one of the following options:

IMPORTANT REMINDER: An separate application will need to be completed for each child you would like considered for enrollment.

Having trouble submitting the electronic application? Print the PDF to complete and mail!

Student Information

Family Information

Religious Information

Medical Information

Scholastic Information

General Information

The application must be filled out completely before it will be processed. The application fee must accompany the application and is non-refundable. An interview with the parents and the applicant will be required before final acceptance.

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