Registration Application

Student Information

Student's Name*

Name to be Used at School

Address*

Student's Gender*

Student's Ethnicity*

Used for mandatory state reporting purposes only.

Birthdate*

Phone*

Email Address*

School District*

Current PVNS Family?*

Yes

No

Alumni PVNS Family?*

Yes

No

Parent/Guardian Information

Parent/Guardian #1*

Place of Employment*

Work Phone

Cell Number*

Parent/Guardian #2

Place of Employment

Work Phone

Cell Number

Programs

Classes & times are subject to change. All classes have a minimum number needed to run.

Class Options*

Acknowledgement*

I acknowledge that my child MUST be fully Potty Trained prior to September 1st.

Are you considering your districts UPK?*

Yes

No

Are you considering your districts UPK?*

Yes

No

Student Placement

Placement Request? (Carpool, time, friend etc.) We cannot guarantee you will get your first choice, but every effort is made to create the best educational environment for each child.

You will be notified via email if your child has been added to a class or placed on a waitlist.

Parent/Guardian Signature*

Reset

Date*

Registration Fee

A $100 application fee is due within 48 hours of application submission. I acknowledge that payment is due within 48 hours of application submission. Failure to pay the application fee within 48 hours will result in a hold on your application.

I acknowledge.

Payment Type*

Pay by Credit Card

Pay by Check

Registration Fee*

Please note; the application fee non-refundable and non-transferable in the event you choose to withdraw your child.