Re-enrolling Student Application Form

Student’s Last Name

Student’s First Name

Student’s Middle Name

Social Security Number

Home Address

City

State

ZIP Code

Phone

Date of Birth

Gender

Male

Female

Birthplace

Grade Entering

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

Freshman

Sophomore

Junior

Senior

Current Grade

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

Freshman

Sophomore

Junior

Senior

Father’s (or Male Guardian’s) Full Name

Occupation

Employer

Work Address

Work Phone

Cell Phone Number

Primary E-mail Address

Mother’s (or Female Guardian’s) Name

Occupation

Employer

Work Address

Work Phone

Cell Phone Number

Primary E-mail Address

Name of Emergency Contact (Other Than Parent)

Emergency Contact’s Phone Number

Family Status

Married

Divorced

Widowed

Remarried

Single Parent

If the child is not living with both parents, please explain with whom he lives.

Names of brothers and sisters attending North Valley Baptist Schools.

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