Valley Harvest Ministries
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Christian School
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:
app fee for 1 student
App Fee for 2 Students
App fee for 3 students
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!
print application
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
Marital Status
Married
Divorced
Widowed
Separated
Single
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