Quick Enrollment Form

Child's Full Name

Grade Child Will Be Going into

Child's Primary Address

Address Line 1

Address Line 2

Parent or Guardian Phone Number

Child's Date of Birth

Information we should be aware of (custody, medical, etc.):

Military Student Identification

Parents and/or legal guardians may decline to answer; in which case, the student will be assumed not to be a dependent of a member of the U.S. military.

The United States military services, defined as one of the following:

1. Active Duty Army, Navy, Air Force, Marine Corps, or Coast Guard

2. Full-time member of the National Guard or Reserve Forces of either the U.S. Army, Navy, Marine Corps, or Air Force

3. Member of the National Guard or Reserve Force of either the U.S. Army, Navy, Marine Corps, or Air Force

Student is a dependent of a member of the United States military services, defined above:

YesNo

Disciplinary History

This information is collected pursuant to A.R.S. § 15-184(I) and may be a consideration for enrollment.

Has the student ever been expelled from a previous school?

YesNo

Is the student in the process of being expelled from another school?

YesNo

If the answer to either of these questions is “yes”, please explain:

What is your full name?

What is your E-mail Address?

How did you hear about Prescott Valley School?

Referred by

If other, please explain

Welcome to
Prescott Valley Charter School!