Valley Harvest Ministries

Valley Harvest Christian School

Student Application

Openings are available for Kindergarten through 8th grade only

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

Student Information

Student's Full Name (First, Middle and Last)

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Age

Birthdate

Gender

Male

Female

Birthplace

School Last Attended

Address of Last School Attended:

Last Grade Completed

What academic year is the applicant applying for? (ex. 2025-2026)

Family Information

Father's Full Name (First, Middle, and Last)

Father's Employer

Father's Role with Employer

Father's Business Phone Number

Father's Email Address

Mother's Full Name (First, Middle, and Last)

Mother's Employer

Mother's Role with Employer

Mother's Business Phone Number

Mother's Email Address

Marital Status

Single

Married

Divorced

Separated

Additional Emergency Contact (If parents/guardians cannot be reached)

Emergency Contact Phone Number

Does the applicant have a sibling who already attends VHCS?

Yes

If so, what is the name of the applicant's sibling(s)?

Faith Information

Name of the church your family attends:

Church's Address

Church's Phone Number

Pastor's Name

Pastor's Phone Number

Is the student's father a Christian?

Yes

Is the student's mother a Christian?

Yes

Has the student ever made a profession of faith in Christ?

Yes

Medical Information

Student's Physician

Physician's Address

Physician's Phone Number

Does the student have any medical issues, mental health diagnoses, physical issues, or allergies that school staff need to be aware of? If so, please explain:

Scholastic Information

If the application has attended public school previously, did they have an IEP, 504 plan, special accommodations, etc.?

Yes

Not Applicable

If the applicant has attended public school previously and has an IEP, 504 plan, special accommodations, etc., please give us additional details:

Has the applicant ever been expelled, suspended, or been refused admission to another school?

Yes

If the applicant has been expelled, suspended or been refused admission, please explain:

Has the applicant ever had disciplinary difficulty at school?

Yes

If the applicant has ever had disciplinary difficulty at school, please explain:

Does the applicant have a juvenile or arrest record?

Yes

If the applicant has an arrest record, please explain:

Has the applicant ever used tobacco or nonprescription drugs of any kind?

Yes

Choice Three

If the applicant has ever used tobacco or nonprescription drugs of any kind, 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

If yes, what subject(s)?

General Information

How did you hear about our school?

What was your reasoning behind selecting our school?

Next Steps

You will receive a confirmation message on the next screen when you have successfully submitted your application.

A member of our administration team will be in touch with you in late spring (prior to the beginning of the academic year for which you are applying) to schedule a tour and family meeting.

If you have any questions, please give us a call at 540-267-6449.

Submitting the Application

THE APPLICATION MUST BE FILLED OUT COMPLETELY BEFORE IT WILL BE PROCESSED. A MEETING WITH THE PARENTS AND THE APPLICANT WILL BE REQUIRED BEFORE ACCEPTANCE.

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