Paradise Valley Christian Preparatory
High School Application
11875 N. 24th Street
Phoenix, AZ 85028
Phone: 602 992-8140 • Fax: 602 992-8152
Web: www.paradisevalleychristian.org
We welcome your interest in Paradise Valley Christian Preparatory. Admission to the school is based upon
the admissions policy and agreements contained herein. It is important for you to read all of the information
carefully and to fill out all forms completely.
About Paradise Valley Christian Preparatory
It is the purpose of the school to provide a sound academic education integrated with a Christian world-view of God and the
world. The Christ-centered educational approach presents the Biblical truth about God, life and living, our world and the nature of man. Additionally, Christ-centered education presents the Word of God as the only authoritative source upon which to
build a life that has purpose and meaning and teaches how to love all mankind through Christ who first loved us. Students
are taught that all truth originates from God, that all knowledge and wisdom comes from God including history, geography,
science, music and the arts, and that Jesus Christ is to be central in all learning and living.
The PVCP Panthers participate in many inter-scholastic events. These include academic competitions, art programs, drama,
field trips, musical groups and concerts, as well as the sports of baseball, volleyball, soccer, basketball, softball, golf and
cross country.
Application Procedures
1)
Schedule a tour of the campus with the Admissions Office.
2)
Complete the application packet (use checklist). Include in your child’s packet his/her last three years of report
card, standardized testing scores, birth certificate and all academic records from previous schools.
3)
Return the completed application packet along with the remittance of $250.00 new family application fee and
$175.00 per child registration fee. After 7 days of acceptance no portion of any fee is refundable.
4)
Contact the Admissions Office to schedule an appointment for an interview and testing.
Admissions Preamble
Christian education involves the whole person; therefore, it is desirable that all elements, which bear on the education of a
child, be consistent and properly reinforces one another.
In view of this, it is of paramount importance that a Christian home and a Christian church support a Christian school. Paradise Valley Christian Preparatory was founded to educate the children of Christian parents. All three should be complementary, which means that all three should be in Biblical agreement for a truly well rounded Christian education of the child. It is,
therefore, necessary that all parents agree with the philosophy and teaching of the school and be involved in their church.
Philosophy
The educational philosophy of Paradise Valley Christian Preparatory is dependent upon the Bible for providing the viewpoint
for interpreting any subject or any school activity. The entire process of education is seen as a means used by God to bring
the student to Himself through faith in Christ. Christian education is used to develop a Christian’s mind for the fulfillment of
God’s will for the student’s vocation and life. The mandate for Christian education comes from God’s command that children
are to be taught to love God and to give Him pre-eminence in their lives and from Biblical teaching that parents are responsible for the total education of their children.
Admissions Policies
1)
The parents must be born-again, Bible believing, Christ honoring Christians. (An exception may be made when only one
parent is a born-again believer provided the non-believing spouse agrees not to oppose the Biblical teaching of the
school.) The parents must declare in writing that they have accepted and continue to acknowledge Jesus Christ as their
personal Lord and Savior.
2)
The parents must state in writing that they have read and agree with the Statement of Faith of the school, and both parents must agree to have their children educated in accordance therein.
3)
The parents must agree in writing that:
A)
The school has full discretion in the discipline of their children within bounds of the discipline policy.
B)
The school has full discretion for the grade placement of children.
C)
They will meet all tuition and other financial obligations to the school.
D)
They will willingly support the school in prayer and in lending practical help as required by the school.
E)
They have read, agree with, and will perform as is required by the Parent’s Code.
4)
The school headmaster must interview parents and students (as age appropriate).
5)
All families should be in active fellowship with a Bible believing church.
6)
All prospective students in grades 1-8 will be given an entrance test to determine if the student fits the educational capabilities of the school. (Exceptions granted based on prior testing records.)
7)
Prospective kindergarten students must be five years old by September 1st of the school year.
8)
Families will be accepted in order of date of receipt of the complete application packet and application fees. Students of
school families have priority over students of prospective school families on the waiting list upon admission of their first
child, teachers and staff of PVCP will be considered school families and will also have priority as a school family.
9)
The headmaster may refuse to admit a student with severe disciplinary, psychological or learning problems. It is and
shall be the policy and practice of PVCP in the admission of students or the hiring of employees not to discriminate on
the basis of gender, race, color or national and ethnic origin.
Statement of Faith
The basis of faith shall be the Word of God as interpreted by the following:
1)
We believe that the Bible, made up of 66 books, verbally inspired and free from error in doctrine, fact and ethics, i.e.
inerrant, is the Word of God and the only infallible and authoritative rule of faith and practice.
2)
We believe in one triune God, eternally existent in three equal persons - Father, Son and Holy Spirit.
3)
We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and
atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father and in
His personal and physical return in power and glory.
4)
We believe that man was created in the image of God; that through sin he brought upon himself and his posterity, not
only physical death, but also spiritual death which is separation from God; that all human beings by physical birth possess a sinful nature and are, therefore, actual sinners in thought, word and deed; and that man, as such, is condemned
to hell and utterly unable to remedy his condition by himself or by ecclesiastical rite.
5)
We believe that the salvation of lost and sinful man is a free gift of God’s grace apart from works, based solely upon His
vicarious and atoning death, effected by the regenerating work of the Holy Spirit and received by trusting in Christ’s finished work on the cross.
6)
We believe in the present ministry of the Holy Spirit, by whose indwelling the Christian is enabled to live a Godly life.
7)
We believe in the resurrection of both the saved and the lost - they that are saved, to the resurrection of life and they that
are lost, to the resurrection of damnation.
8)
We believe in the spiritual unity of all believers in the Lord Jesus Christ.
9)
We believe that Biblical marriage is limited to a covenant between a man and a woman. (Matthew 19:4-6)
Paradise Valley Christian Preparatory Parent’s Code
1)
I will pray earnestly for Paradise Valley Christian Preparatory.
2)
I will cooperate fully in the educational functions of PVCP doing my best to make Christian education effective in the
life of each of my children in order that he or she may love and serve the Lord Jesus Christ in all of his or her life.
3)
I will maintain a Christian lifestyle that commensurate with the biblical values espoused by the school.
4)
I will pay all of my financial obligations to PVCP on or before the date due. If I am ever unable to pay on time, I will
notify the school in advance giving both a reasonable explanation for the delay as well as stating when the payment
can be made.
5)
I will support the school by gifts in addition to my tuition payments and fees, as the Lord enables. (As God has prospered us, may we be faithful to Him.)
6)
I will fulfill my 20 hours of volunteer service (cleaning, serving on committees, grounds upkeep, etc.) or donate
$200.00 to the school cheerfully as to the Lord and on time, doing more than my share, as the Lord permits.
7)
I will undertake volunteer duties and responsibilities for PVCP as opportunities arise and as God provides time and
strength.
8)
I will recommend PVCP to other Christian families as the occasions occur.
9)
I will attend Parent/Teacher meetings and other functions of the school regularly, even though I may not be able to
achieve perfect attendance.
10) If I become dissatisfied with the school in any respect, I will seek to resolve the matter with the person or persons
involved rather than begin to spread criticism or hold a negative attitude in my heart.
11) I will seek the advancement of PVCP in all areas, spiritually, academically and physically.
Paradise Valley Christian Preparatory Mission Statement
Our Mission, for the Glory of God, is to be the college preparatory of choice.
Our objectives are five-fold:
•
To provide a scholarly, Christ centered community instilling Biblical values by nurturing spiritual growth.
•
Establish, assess, and achieve clear and measurable academic learning goals.
•
Recruit, develop and retain quality, Christian, professional educators and staff.
•
Foster parental involvement and effective communication.
•
Model exemplary stewardship of our God-given resources.
In these ways we will partner with parents in the pursuit of preparing exemplary Christian citizens and servant leaders.
Our Vision: Building the kingdom through children.
11875 N. 24th Street
Phoenix, AZ 85028
Phone: 602 992-8140 • Fax: 602 992-8152
Web: www.pvcp.org
Dear Prospective Parents,
Thank you for giving prayerful consideration to enrolling your child/children at Paradise Valley Christian Preparatory. We affirm
our partnership and commitment for the glory of God to be the college preparatory of choice. It is a privilege to serve with
Christian families, who are like-minded in fulfilling the Biblical mandate from the book of Proverbs. “Train up a child in the way
he should go, and when he is old he will not depart from it.” (Proverbs 22:6)
Enclosed you will find all of the necessary forms to complete the enrollment process for your child. Open enrollment begins
February 1st for new families. For your convenience, we have provided an “Enrollment Checklist” below. All of the information below must be completed and returned with the registration fee to PVCP before a student will be enrolled. If you have
additional questions, please call our Admissions Office at 602-992-8140 ext.2231.
Sheryl J. Temple
Headmaster
Juliana Mays
Director of Admissions
NEW HIGH SCHOOL ENROLLMENT CHECKLIST
_____
1 High School Enrollment Form (Please be sure to indicate your payment plan on side two.)
_____
1 Family Information Form
To be completed by both custodial parents/guardians. (Copies will be made for additional student files)
_____
1 Medical Info Form & copy of immunization record
This form must be signed by a parent or guardian in the presence of a notary. A notary is available in the
office. Be sure to read and sign Side 2 .
_____
1 Pastor Recommendation Form
Complete top portion and have your pastor complete the rest and return to PVCP by mail or fax.
_____
1 Principal’s Recommendation Form
_____
3 Teacher Recommendation Forms
_____
Signed Parent-Student Contract
_____
1 Transcript Release Form
_____
1 Volunteer Service Form
_____
1 Driver Information/Release Form
_____
Private School Affidavit
_____
Birth Certificate (Please include a copy of your child’s birth certificate.)
_____
Copies of last three years of report cards and standardized testing scores
_____
A family interview with the headmaster will be scheduled upon completion of the application process.
_____
A student interview with the High School Admissions Committee will also be scheduled upon receipt
of enrollment paperwork.
_____
Remittance of $250.00 new family application fee due with the enrollment packet.
(After 7 days of acceptance the fee is non refundable.) ________ Please initial.
_____
Remittance of $175.00 registration fee per student due with the enrollment packet.
(After 7 days of acceptance the fee is non-refundable. Within 7 days after acceptance, registration fee is refundable less $50.00 per student. ) ________
Please initial.
Our mission, for the glory of God, is to be the college preparatory of choice.
ENROLLMENT FORM
Payment Plan: _____________________________
11875 N. 24th Street., Phoenix, AZ 85028
602-992-8140, Fax: 602-992-8152
OfficePrint
Use:
Please
Prorated Tuition: __________________________
Start Date______________ Registration Fee Paid Cash
Child Order: ____________ New Family Fee Paid Cash
Check#____________ Date Pd:_________________
Check#____________ Date Pd:_________________
Grade applying for______ School Year__________ New Enrollment?
Pre-school 2 Day
Pre-school 5 Day
Half-day
Half-day
Half-day w/lunch hour
Half-day w/lunch hour
Yes
Full Day Pre-school 3 Day
Full Day
No
Half-day
Half-day w/lunch hour
Student Name_____________________________________________________________________________
Last
First
Middle
Full Day
M
F
Goes By
Address________________________________________________________________ Birth Date___________________
Street
_______________________________________________________________ Home Phone________________________
City
State
Zip
Area code
Family Email Address_________________________________________________________________________________
Father / Step-Father / Guardian
Mr.
Dr.
Rev.
Mother / Step-Mother / Guardian
(Circle one)
Other______________________
Ms.
Mrs.
Dr.
(Circle one)
Other______________________
Full Name______________________________________
Full Name_______________________________________
Address_______________________________________
Address________________________________________
(If different)
(If different)
______________________________________________
_______________________________________________
Employer______________________________________
Employer_______________________________________
Occupation /Title_________________________________
Occupation /Title_________________________________
Bus. Phone_____________________________________
Bus. Phone______________________________________
Area code
Area code
Cell Phone_____________________________________
Cell Phone______________________________________
Area code
Area code
Home Phone____________________________________
Home Phone____________________________________
Area code
E-Mail
Area code
______________________________________
Parents’ marital status: Married
Single
Divorced
E-Mail
Separated
______________________________________
Remarried
Mother Deceased
Father Deceased
If parents are divorced or separated, who has legal custody of the student?_______________________________________
If divorced, should birth parent be placed on mailing list?
Yes
No If yes, indicate name and address below:
Name_____________________________________________________________________________________________
Address/City/State/Zip________________________________________________________________________________
Student Ethnicity (for internal use only):
Caucasian
African Amer.
Arab
Asian
Hispanic
Indian
Other
Name of family church_________________________________________________ Denomination:
Address______________________________________________ City_______________________ Zip Code:_________
Phone_____________________________________ Pastor__________________________________________________
Does your family regularly attend and support the church listed above?
Yes
No If no, please explain:_____________
__________________________________________________________________________________________________
How long has your family been attending this church?_____________ Does your child attend Sunday School?
OVER
Yes
No
Current School_______________________________________________________________________________________
Name
Address and Phone
Has the student been dismissed or suspended from school?
Yes
No If yes, explain____________________________
___________________________________________________________________________________________________
Has the student repeated a grade?
Yes
Experienced learning difficulties in reading?
No If yes, which grade?____________ Received Tutoring?
Yes
No
Yes
Yes
No
No
Math?
Yes
No
Ever referred for testing?
When?__________ Type of testing_________________________ Was testing completed?
Is the student taking medication to improve his/her ability to function in the classroom?
Does the student have any physical disabilities?
Yes
Yes
No (Please attach
test results)
Yes
No
No If yes, explain:_____________________________________
___________________________________________________________________________________________________
Are there any unusual factors in the student’s life? (Serious Illnesses, Accidents, Adoption, Absence of Parent(s), Etc.)
If yes, explain:________________________________________________________________________________________
Do you have any outstanding accounts at any other educational institution?
Tuition Payment Plan*:
Payment in full by July 1st
2 payments (July & Dec.)
11 Month Plan (July – May)
Other (Enrolled after July 1st)
*See Tuition Schedule for rates.
Yes
No
Extended Day Payment Plan (Full time students only):
(Indicate need)
Morning care 7am-8am
Afternoon care 3pm-5:30pm
Morning and Afternoon care
Bill To:_________________________________________________________________ Phone _____________________
Area code
Address_______________________________________________________________Bus. Ph. _____________________
Area code
____________________________________________________________________Mobile Ph. _____________________
City
State
Zip
Area code
New Enrollment Form:
By signing below, I am acknowledging receipt of the Enrollment Packet, including the PVCP Family
Handbook (given during New Family Interview), PVCP Tuition & Fee Schedule for the upcoming year
and the Extended Day Care (EDC) Policy Form. I further agree to abide by all policies and requirements stated therein.
Father’s Signature
Date
Mother’s Signature
Date
FAMILY INFORMATION
11875 N. 24th Street, Phoenix, AZ 85028
Phone: 602 992-8140 Fax: 602 992-8152 website: www.pvcp.org
Web: www.paradisevalleychristian.org
Other children in the family:
Name
Age
School Attending (if applicable)
______________________________________
_____
________________________________________________
______________________________________
_____
________________________________________________
______________________________________
_____
________________________________________________
Grandparent Information
Name_____________________________________________________________________________________________
Address____________________________________________________________________________________________
Street
City
State
Zip
Name_____________________________________________________________________________________________
Address____________________________________________________________________________________________
Street
City
State
Zip
What is your personal understanding of the New Testament passage found in John 3:1-7?
(Use additional sheets if necessary)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Relate, in detail, how and when you received Christ as your personal Savior, and His meaning in your life at the
present time. (Use additional sheets if necessary)
Father:____________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Mother:____________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
In your view, what is the purpose of Christian education and your reasons for desiring a Christian education for
your child?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please share any differences you have with the school’s statement of faith and/or commitments (refer to the folder).
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Commitment Statement of Parent or Guardian
1)
I have read and agree with the Statement of Faith of the school and am willing to have my children educated in accordance with it.
2)
It is my responsibility to strive diligently toward the observance of the Parent’s Code as God enables me by the power of
His Holy Spirit.
3)
The school's position is that Biblical marriage is limited to a covenant between a man and a woman. (Matthew 19:4-6)
4)
The school has full discretion in the discipline of my child in accordance with its discipline policy.
5)
The school has discretion for the grade placement of my child.
6)
The school reserves the right to dismiss any student who does not respect its spiritual standards or cooperate in the
educational process.
7)
We understand that our failure to report psychiatric counseling, any prescribed program of medication, or involvement
with juvenile authorities during the past 3 years may be cause for immediate dismissal.
8)
I understand that tuition rates do not cover the cost of operating the school and thus my participation is needed in lending practical help and prayer support in a mutual effort to train our children; therefore, we commit 20 hours of voluntary
service or donate $200.00 to PVC.
9)
I have read the “Policies Relating to Tuition Payments” (on the back of the tuition schedule) and agree to pay all tuition
fees and other financial obligations to Paradise Valley Christian Preparatory on or before the due date without a reminder and in accordance with these policies.
10) I have read the student dress code and PVC Policies and Objectives and will support these policies and objectives.
11) My child is covered by an insurance policy hereby releasing PVC from any responsibility in case of accident or injury.
12) I understand my child may be photographed or videotaped by the school during the course of school activities. I give my
consent that my child’s photo may be reproduced for PVC’s use in promotional and/or advertising materials.
13) I/we understand that enrollment is subject to verification and approval of this application. I/we also understand that is the
policy of PVC to investigate all statements contained in this application, directly or through a credit reporting agency
before approving a monthly payment plan. I/we authorize the schools and employers listed on this application to give you
any information they may have that is pertinent to our enrollment at PVC.
I/we understand, agree and commit to all the above statements.
_____________________________________
_______________
(Signature of Father/Guardian)
(Date)
_____________________________________
_______________
(Signature of Mother/Guardian)
(Date)
Paradise Valley Christian Preparatory does not discriminate on the basis of race, color, national origin, or handicap in application, admission, participation, access, and treatment of persons in instructional or employment programs and activities.
New Student—MEDICAL FORM
11875 N. 24th Street, Phoenix, AZ 85028 Phone: 602 992-8140 Fax: 602 992-8152, Web: www.pvcp.org
Birth Date:____/____/____
Student Name:_____________________________________________________________ Grade for 2017-2018:____________
Mother or Guardian
Father or Guardian
Name:________________________________________________________
Name:_________________________________________________________
Address:______________________________________________________
Address:_______________________________________________________
City, State, Zip_________________________________________________
City, State, Zip__________________________________________________
Hm. Ph.:________________________ Cell:__________________________
Hm. Ph.:________________________ Cell:___________________________
Wk. Ph.:______________________________________________________
Wk. Ph.:_______________________________________________________
In case of an emergency, or if I cannot be contacted to pick up my child, I hereby authorize the following person(s) to pick up my child:
Name:_______________________________________________________
Name:_________________________________________________________
Address:_____________________________________________________
Address:________________________________________________________
City, State, Zip________________________________________________
City, State, Zip___________________________________________________
Phone:_______________________________________________________
Phone:_________________________________________________________
Relationship to child:____________________________________________
Relationship to child:______________________________________________
Name:_______________________________________________________
Name:_________________________________________________________
Address:_____________________________________________________
Address:________________________________________________________
City, State, Zip________________________________________________
City, State, Zip___________________________________________________
Phone:_______________________________________________________
Phone:_________________________________________________________
Relationship to child:____________________________________________
Relationship to child:______________________________________________
Special Medical Conditions
_____ Student’s Estimated Weight (lbs.)
Please list any allergies (foods, pollen, medications,…)
Please list any medical conditions your student has (asthma, diabetes, epilepsy, ADD, ADHD,…)
Please list any eye conditions (near sighted, far sighted, contacts, glasses,…)
Please list any medications taken:
Other helpful information:
In case of minor accident or illness during the school day, I authorize the school nurse or designee to administer the over-the-counter medications
and dosages indicated below, not to exceed one dose/day.
Parent signature _____________________________________
Please initial the medications and indicate the dosages your child may receive:
_____ Adult Tylenol (Acetaminophen) 500 mg./tablet
_____ Number of tablets
_____ Children’s chewable Tylenol (Acetaminophen) 80 mg./tablets
_____ Number of tablets
_____ Children’s Tylenol Elixir (Acetaminophen) 160mg./teaspoon
_____ Number of teaspoons
_____ Adult Motrin (Ibuprofen) 200 mg./tablet
_____ Number of tablets
_____ Children’s Motrin Elixir (Ibuprofen) 100mg./teaspoon
_____ Number of teaspoons
_____ Benadryl Liquid (Antihistamine) 12.5 mg./teaspoon
_____ Number of teaspoons
_____ Cough drops with Menthol Eucalyptus as needed.
_____ Tums Antacid (generic) _____ Number of tablets.
_____ Eye drops (artificial tears) as needed.
Medical Treatment Consent
BE IT KNOWN THAT I/WE, the undersigned parent or guardian, do hereby give and grant to any medical doctor or hospital, my/our consent and authorization to render
such aid, treatment or care to our child, that in the judgment of said doctor or hospital, may be required, on an emergency basis, in the event that the child should be
injured or stricken ill while participating in an activity sponsored or sanctioned by Paradise Valley Christian Preparatory.
IT IS UNDERSTOOD that the consent and authorization hereby given and granted are continuing, and are intended by me/us to extend for as long as the child is
involved with Paradise Valley Christian Preparatory.
IT IS FURTHER UNDERSTOOD that any expenses incurred will be paid for by insurance of the parent/guardian of the child; payment of the expense shall in no case be
the responsibility of Paradise Valley Christian Preparatory.
Dated this________ day of __________________, 20_______ at______________________________________, Arizona.
(City and County)
_______________________________________________ In witness whereof I hereunto set my hand and official seal.
Signature of Parent/Guardian
________________________________________________
Notary Public Signature
IMMUNIZATION REQUIREMENTS
House Bill #2295 went into effect on January 1, 1992 requiring all NEW school entrants to
show VERIFIABLE DOCUMENTS before the child can be admitted to school. Parental recall
of dates and types of immunizations received is no longer acceptable. This law pertains to
ALL Arizona schools, both public and private. Acceptable or “documented” proof of
immunization includes: an immunization record book from any state, county, or country; or a
copy of an immunization record from a health agency, clinic or doctor’s record with a
signature or clinic stamp, or on a paper with the clinic’s or physician’s letterhead. This
document must show the date and type of each dose administered. Copies of any of the
above documented proofs of immunization are also acceptable. If you do not have
documentation of your child’s immunizations, you may need to obtain laboratory evidence of
immunity. If you have any questions, please call PVCP at 602 992-8140.
It is MANDATORY that documented proof of immunizations is received BEFORE your child is
ready to begin school. Failure to comply with this mandate will place the school in the position
of being unable to allow your child to begin classes until we receive the required immunization
record.
We will be glad to assist by making copies of any of your child’s immunization records.
I, ______________________________________ (Print Name) have read and understand the above
information and have turned in proof of the required immunizations on ____/____/____ (Date).
I, ______________________________________ (Print Name) have read and understand the above
information and will turn in proof of the required immunizations on ____/____/____ (Date) prior to
attendance of my student.
_________________________________________________
__________________________
Parent’s Signature
Date
PASTOR’S RECOMMENDATION
Section 1—Family Information: (To be completed by family)
After you have completed the Family Section, please give this to your pastor or spiritual leader to complete and mail or
fax directly to the school.
Family Name: ___________________________________________________________________________
Address________________________________________________________________________________
Telephone: _____________________________________________________________________________
Names and grades of children applying to PVCP:
1. _________________________ ________
Name
3. __________________________ ________
Grade
Name
2. __________________________ ________
Name
Grade
4. __________________________ ________
Grade
Name
Grade
Section 2—Pastor’s Recommendation: (To be completed by the Pastor or Spiritual Leader and mailed or faxed
directly to PVCP)
Is the above family an active member of your church?
Yes
No
Have any members of the family held a leadership position in the church?
Yes
No
If yes, please explain:
________________________________________________________________________________________________
Are the children active in the youth program of the church?
Yes
No
Do you consider the children open to spiritual instruction?
Yes
No
What is your understanding of this family’s relationship to God?
________________________________________________________________________________________________
________________________________________________________________________________________________
Are there any matters that you feel would be helpful to us as a school to know influencing the admission of this family?
________________________________________________________________________________________________
________________________________________________________________________________________________
Do you recommend this family for admission to Paradise Valley Christian Preparatory?
Yes
No
Pastor’s Name (Print Please)__________________________________________________________________________
Pastor’s Signature ___________________________________________________________ Date ________________
Church Name ___________________________________________________________Phone #:___________________
Address _________________________________________________________________________________________
Street
State
11875 N. 24th Street · Phoenix, AZ 85028
Phone 602 992-8140 · Fax 602 992-8152 · www.pvcp.org
Zip
RECOMMENDATION FORM
PRINCIPAL’S RECOMMENDATION FORM
Paradise Valley Christian Preparatory
Director of Admissions
11875 N. 24th Street
Phoenix, AZ 85028
Phone (620) 992-8140
Fax (602) 992-8152
www.pvcp.org
INSTRUCTIONS TO PARENTS:
Please fill out the top portion, sign, and give the form to your son or
daughter’s principal or authorized officer at his/her school. Ask that
it be completed. This form is required at time of enrollment.
Thank You!
Name of Applicant:__________________________________________________________________ Applying to Grade:____________
My son/daughter is applying for admission to Paradise Valley Christian Preparatory. I would appreciate your completing this form and
returning it directly to the address given above or to the applicant’s parent/guardian. I hereby authorize the release of my child’s records,
grades, test ratings, psycho-educational batteries, and evaluative data pursuant to this request. I understand that this information is confidential and further acknowledge there is no future liability for either your offices or Paradise Valley Christian Preparatory in the handling
of this information.
Date:__________________ Signature of Parent or Guardian:____________________________________________________________
Name of School:___________________________________________ Form Completed by:_______________________
School Address:___________________________________________________________________________________
Phone Number:____________________
Length of Time Acquainted with Student:_____________________
Do you place students according to ability?______ If so, what are the placements of the applicant for reading and math?
________________________________________________________________________________________________
Does the candidate have any significant limitations (physical, social, emotional)?________________________________
________________________________________________________________________________________________
Is the candidate’s record with you a true index of ability, or have outside circumstances interfered with academic achievement (i.e. illness, excessive involvement in extracurricular activities, difficult home situations, etc.)?________ If not a true index, please explain:_______________________________________________________________________________
________________________________________________________________________________________________
This student has been sent to my office for disciplinary problems:
Often
Seldom
Never
This student has been suspended _______ times.
Has the student been suspended and therefore not eligible to return next year?
Yes
No
Please indicate your rating by numbers in the right hand column. Use a question mark where you have insufficient evidence.
Rating
INTEGRITY
5
Exceptionally upright
CONDUCT
Outstanding in
every respect
LEADERSHIP & Outstanding, top
RESPONSIBILITY positions, contributes most
INTEREST IN
Outstanding
NON ACADEMIC
ACTIVITIES
RESPECT FOR
Works very well
AUTHORITY
with those in authority
PARENTAL SUPExceptional
PORT
SUMMARY
Outstanding
4
3
Noticeable upright Upright, no cause
to question
Generally excellent Good or acceptable
Commendable, top Capable, minor
or next to top posipositions
tions
Commendable, top
Active
or next to top activities
Works well with Mild resistance to
those in authority
authority
Quite good
Average
Excellent
Good
2
1
#
Weak or questiona- Record of dishonesty
ble
Marginal
Poor or reprehensible
No sign of leader- Record of irresponsiship or involvement
bility
Minor participation
No participation
Periodic rebellious- Often unsupportive,
ness to authority
critical of school
Sometimes unsup- Often unsupportive,
portive
critical of school
Fair
Poor
Outstanding talents, accomplishments, or reservations not covered by the above categories:___________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
6/13
This release is in accordance with the provisions of the Family Education Rights and Privacy Act of 1974.
RECOMMENDATION FORM
TEACHER’S RECOMMENDATION FORM
Paradise Valley Christian Preparatory
Director of Admissions
11875 N. 24th Street
Phoenix, AZ 85028
Phone (602) 992-8140
Fax (602) 992-8152
INSTRUCTIONS TO PARENTS:
Please fill out the top portion, sign, and give the form to three of your son or
daughter’s teachers at his/her school. Ask that it be completed.
This form is required at time of enrollment.
Thank You!
Name of Applicant:__________________________________________________________________ Applying to Grade:____________
My son/daughter is applying for admission to Paradise Valley Christian Preparatory. I would appreciate your completing this form and returning it directly to the address given above or to the applicant’s parent/guardian. I hereby authorize the release of my child’s records, grades,
test ratings, psycho-educational batteries, and evaluative data pursuant to this request. I understand that this information is confidential and
further acknowledge there is no future liability for either your offices or Paradise Valley Christian Preparatory in the handling of this information.
Date:__________________ Signature of Parent or Guardian:____________________________________________________________
_____________________________________________________________________________________________
Printed Name/ Signature/ Position
Date
_____________________________________________________________________________
School
Address
Work Phone
_____________________________________________________________________________
E-mail
Cell Phone
NOTE: If you wish this information to remain confidential, please indicate by checking the box □
1. How long have you known the student? ________________ In what capacity? _________________________
2. Description of student (circle all that are applicable)
Behavior
well-behaved, needs discipline, respects authority, does not respect authority,
ambitious, over aggressive, retiring
Peer Influence very good, good, indifferent, bad ,very bad
Attitude
emotionally stable, emotionally erratic, optimistic, pessimistic, self-centered, considerate
Characteristics studious, athletic, social, musical, mechanical, artistic
Leadership
leader, follower If a leader, what evidence has been demonstrated:
3. How would you rate this student academically? (Circle one)
above average
average below average
capable of better work
4. Describe the applicant’s academic effort including following instructions, attentiveness, etc.
___________________________________________
__________________________________________________________________________________________
5. Would you like to have this student in your class again? ___________________________________________
__________________________________________________________________________________________
6. Describe your working relationship with the family: parents and student. ____________________________
__________________________________________________________________________________________
___________________________________________________________________________________________
7. Outstanding talents, accomplishments, or reservations not covered by the above categories:_____________________________
_________________________________________________________________________________________________________
8. Please use the back of form for any additional information which you feel might help us in our evaluation.
This release is in accordance with the provisions of the Family Education Rights and Privacy Act of 1974.
RECOMMENDATION FORM
TEACHER’S RECOMMENDATION FORM
Paradise Valley Christian Preparatory
Director of Admissions
11875 N. 24th Street
Phoenix, AZ 85028
Phone (602) 992-8140
Fax (602) 992-8152
INSTRUCTIONS TO PARENTS:
Please fill out the top portion, sign, and give the form to three of your son or
daughter’s teachers at his/her school. Ask that it be completed.
This form is required at time of enrollment.
Thank You!
Name of Applicant:__________________________________________________________________ Applying to Grade:____________
My son/daughter is applying for admission to Paradise Valley Christian Preparatory. I would appreciate your completing this form and returning it directly to the address given above or to the applicant’s parent/guardian. I hereby authorize the release of my child’s records, grades,
test ratings, psycho-educational batteries, and evaluative data pursuant to this request. I understand that this information is confidential and
further acknowledge there is no future liability for either your offices or Paradise Valley Christian Preparatory in the handling of this information.
Date:__________________ Signature of Parent or Guardian:____________________________________________________________
_____________________________________________________________________________________________
Printed Name/ Signature/ Position
Date
_____________________________________________________________________________
School
Address
Work Phone
_____________________________________________________________________________
E-mail
Cell Phone
NOTE: If you wish this information to remain confidential, please indicate by checking the box □
1. How long have you known the student? ________________ In what capacity? _________________________
2. Description of student (circle all that are applicable)
Behavior
well-behaved, needs discipline, respects authority, does not respect authority,
ambitious, over aggressive, retiring
Peer Influence very good, good, indifferent, bad ,very bad
Attitude
emotionally stable, emotionally erratic, optimistic, pessimistic, self-centered, considerate
Characteristics studious, athletic, social, musical, mechanical, artistic
Leadership
leader, follower If a leader, what evidence has been demonstrated:
3. How would you rate this student academically? (Circle one)
above average
average below average
capable of better work
4. Describe the applicant’s academic effort including following instructions, attentiveness, etc.
___________________________________________
__________________________________________________________________________________________
5. Would you like to have this student in your class again? ___________________________________________
__________________________________________________________________________________________
6. Describe your working relationship with the family: parents and student. ____________________________
__________________________________________________________________________________________
___________________________________________________________________________________________
7. Outstanding talents, accomplishments, or reservations not covered by the above categories:_____________________________
_________________________________________________________________________________________________________
8. Please use the back of form for any additional information which you feel might help us in our evaluation.
This release is in accordance with the provisions of the Family Education Rights and Privacy Act of 1974.
RECOMMENDATION FORM
TEACHER’S RECOMMENDATION FORM
Paradise Valley Christian Preparatory
Director of Admissions
11875 N. 24th Street
Phoenix, AZ 85028
Phone (602) 992-8140
Fax (602) 992-8152
INSTRUCTIONS TO PARENTS:
Please fill out the top portion, sign, and give the form to three of your son or
daughter’s teachers at his/her school. Ask that it be completed.
This form is required at time of enrollment.
Thank You!
Name of Applicant:__________________________________________________________________ Applying to Grade:____________
My son/daughter is applying for admission to Paradise Valley Christian Preparatory. I would appreciate your completing this form and returning it directly to the address given above or to the applicant’s parent/guardian. I hereby authorize the release of my child’s records, grades,
test ratings, psycho-educational batteries, and evaluative data pursuant to this request. I understand that this information is confidential and
further acknowledge there is no future liability for either your offices or Paradise Valley Christian Preparatory in the handling of this information.
Date:__________________ Signature of Parent or Guardian:____________________________________________________________
_____________________________________________________________________________________________
Printed Name/ Signature/ Position
Date
_____________________________________________________________________________
School
Address
Work Phone
_____________________________________________________________________________
E-mail
Cell Phone
NOTE: If you wish this information to remain confidential, please indicate by checking the box □
1. How long have you known the student? ________________ In what capacity? _________________________
2. Description of student (circle all that are applicable)
Behavior
well-behaved, needs discipline, respects authority, does not respect authority,
ambitious, over aggressive, retiring
Peer Influence very good, good, indifferent, bad ,very bad
Attitude
emotionally stable, emotionally erratic, optimistic, pessimistic, self-centered, considerate
Characteristics studious, athletic, social, musical, mechanical, artistic
Leadership
leader, follower If a leader, what evidence has been demonstrated:
3. How would you rate this student academically? (Circle one)
above average
average below average
capable of better work
4. Describe the applicant’s academic effort including following instructions, attentiveness, etc.
___________________________________________
__________________________________________________________________________________________
5. Would you like to have this student in your class again? ___________________________________________
__________________________________________________________________________________________
6. Describe your working relationship with the family: parents and student. ____________________________
__________________________________________________________________________________________
___________________________________________________________________________________________
7. Outstanding talents, accomplishments, or reservations not covered by the above categories:_____________________________
_________________________________________________________________________________________________________
8. Please use the back of form for any additional information which you feel might help us in our evaluation.
This release is in accordance with the provisions of the Family Education Rights and Privacy Act of 1974.
Parent-Student Contract
The purpose of this contract is to build upon the stated objective of Paradise Valley Christian Preparatory to foster parental involvement and effective communication in establishing a community of spiritual nurturing and academic excellence. This will
provide the vital support needed to meet the basic mission of our school—to glorify God. Our desire is that your involvement
will reinforce and not hinder the educational experience PVCP strives to provide. Open communication between teachers, students, and parents is our central objective. This communication will require the time and effort of each party to ensure that integrity is upheld at each level of responsibility—those of teachers, students and parents.
In pursuit of our mission statement, we will maintain the Biblical standards of Godly discipline for faculty, students, and parents alike. If and when disagreements, concerns, or questions arise regarding any matter concerning your child, the principle
given in Matthew 18 must be applied.1
Since we are seeking to provide an environment of academic excellence, any student in danger of failing or who fails a course
will automatically be placed on academic probation. This probationary period should serve as a call, for both student and parent(s), to consider the reason(s) that has led to the situation. During this period, the student will be required to attend additional
help time with the teacher and possibly additional school tutoring. The latter requirement is subject to the recommendation of the teacher with agreement from parents.
All faculty of PVCP agree to encourage and support students’ spiritual and educational experience in this school by doing the
following:
• Understand, articulate, apply, and defend their Christian Worldview.
• Model seeking first the Kingdom of God and His glory in all areas and relationships of life.
• Begin class with prayer and teach the applications of the Lord’s Prayer
• Make the gospel plain and heard.
• Connect current events with the Biblical Worldview.
• Discuss ways in which meaning/purpose is sought apart from God and show how only true meaning comes in
knowing God and Jesus Christ whom he sent.
• Develop relationships with parents and students to work with student strengths and weaknesses.
• Help students understand that life is about working for the Kingdom (a lasting endeavor).
• Help students connect talents with the Kingdom and glory of God.
• Model a work ethic that reflects quality, punctuality, and thoroughness in subject matter.
• Exercise a love of learning and for God in their professional and personal life.
As a parent, I will encour age and suppor t my child’s spiritual and educational experience by doing the following:
• Require regular student attendance at school.
• Support the guidelines summed up in the PVCP Student Handbook.
• Expect and encourage my student to meet the 4 expectations of a model PVCP student.
• Provide a suitable study area/environment for my child.
• Establish discipline in the home to ensure a regular study time for my child.
• Attend school functions when and where attendance is expected.
• Encourage my child to work for the Lord and His glory above all else.
• Trust the faculty of PVCP will seek the best for my child in all areas of life.
• Follow the principle of Matthew 18 in every relationship of life.
• Set an example for my child in exercising the characteristics of a model PVCP student.
In signing this contract, I understand and agree to all of the requirements.
Signature______________________________________________Date____/____/_________
Please see reverse side for student portion of contract.
1.
See Addendum on reverse side.
As a student, I will demonstr ate my desir e and commitment to my PVCP spir itual and educational exper ience by doing the
following:
• Attend school regularly.
• Read and abide by the PVCP Student Handbook.
• Strive to exemplify the characteristics of the model PVCP student.2
• Take full, personal responsibility in regards to my spiritual and academic growth.
• Discipline myself to meet the academic requirements in every subject with joy.
• If in need of spiritual or academic correction, I will submit to the authority of PVCP.
• Help my peers meet all requirements that I hold accountable to myself.
• Follow the principle of Matthew 18 in every relationship of life.
In signing this contract, I understand and agree to all of the requirements.
Signature______________________________________________Date____/____/_________
Printed Name_________________________________________________________________
2
See Addendum below.
Addendum
1. Parents are encouraged to directly seek out the relevant faculty member with their concern before discussing it with other faculty, students, or parents. If the matter cannot be resolved, parents will be encouraged to set up a meeting with the relevant faculty
member along with another faculty member who teaches the student. Again, this should be done without discussing the concern
with other faculty, students, or parents. If the matter still cannot be resolved, a meeting with the faculty member, parent(s), and
Headmaster will be called (again, this should be done prior to discussing the concern with other faculty, students, or parents). This
is the standard principle that must be followed to avoid gossip and slander and to uphold the righteousness required within
the body of Christ. Failur e to follow this pr inciple will, by God’s grace, be dealt with immediately using the same principle.
2. This school is firmly grounded in a foundation of intense rigor and academic excellence in light of the Church’s calling to be salt
and light to the world. The curriculum and the method of engagement through philosophical analysis will prepare students for college admission. In regards to the current intellectual challenges presented to the Church, PVCP will prepare students to think critically about and respond thoughtfully to these challenges in such a way as to become faithful witnesses of God’s revealed and written Word. As such, a student interested in this program of study must exercise the following:
1. A love of learning as a life-long endeavor
2. A respect for Godly integrity in regards to thought, word, and deed
3. A willingness to meet high academic expectations regardless of grade outcome
4. A desire to fulfill the mission and cultural mandate required of all believers
TRANSCRIPT RELEASE FORM
Please Print
Present or last school:_____________________________________________________________
School Name
_____________________________________________________________________
School Address
_____________________________________________________________________
City, State, Zip
_____________________________________________________________________
Phone Number
Fax Number
Please send all records including:
___
___
___
___
___
Official transcript of grades, credits, and attendance
Standardized test scores
Health and immunization records
Psycho-educational evaluations
Counseling, therapy, or other pertinent records
Permission is hereby granted for a complete transcript showing all former and current grades, IQ and Achievement Test
scores, psychological evaluations (if any), health records, and other pertinent information from the student’s permanent
record. Also please include a copy of the individual’s results of any standardized testing (Aims, Terra Nova, Stanford,
etc.). These are to be released to:
Admissions Office
Paradise Valley Christian Preparatory
11875 N. 24th Street
Phoenix, AZ 85028
Phone: 602 992-8140
Fax: 602 992-8152
Thank you for your cooperation and prompt assistance.
Student’s Full Name
Grade
Birth Date
_____________________________________________
_________
_________________
_____________________________________________
_________
_________________
_____________________________________________
_________
_________________
_____________________________________________
_________
_________________
_____________________________________________
_________
_________________
Signature of Parent/Guardian
Date
Relationship to Child
Withdrawal Date____________________________
This release is in accordance with the provisions of the Family Education Rights and Privacy Act of 1974
VOLUNTEER SERVICE
PLEASE PRINT CLEARLY
Mother’s Name:________________________________ Father’s Name:____________________________
Mother’s Employment: _________________________
Father’s Employment: ______________________
Phone Number: _______________________________ Phone Number: ___________________________
Email: _______________________________________ Email: ___________________________________
New Family? Yes or No
VOLUNTEER / DONOR FORM
Student Name(s):______________________________________
Please choose OPTION 1 or OPTION 2.
OPTION 1: Parents can commit to a minimum of 20 service hours (per family) to help our school. Please check
boxes below where you would like to volunteer. You will be added to a contact list for that area of service.
SCHOOL YEAR: 2017-18
PAC ACTIVITIES (Continued)
PAC ACTIVITIES (Parent Advisory Council)
Fundraising
Mom Dad
$2 Jeans Day
___ ___
“Teacher/staff support & encouragement”
Leadership
Mom
Attend monthly meetings
Serve as Coordinator or Co-Chair
of one of the PAC Activities below
___
___
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___
Dad
Hospitality
Welcome Coffee (1st day of school)
Principal’s List Breakfast (Jan)
Help set up, serve, clean up
Organize food, Decorations
Teacher Appreciation Lunch (Feb)
Bring food/baked goods
Help serve, set-up, clean-up
Prepare decorations
Grandparents Day (Feb)
Teacher Dinners (periodic)
School Picnic (Fall)
Planning
Helper
New Parent Coffee
Campus Support
Copy Cats (photocopying)
Throughout year
Beginning of school (Aug)
Gardens: plant & up keep of gardens
Lost & Found
Clear out bins 1x month
Table Washers
Wash the lunch tables in a.m.
once per week
once per month
Uniform Exchange (3x/year)
Restaurant Nights
Contact restaurants & send
out flyers to classrooms
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Charleston Wrap (Fall)
___ ___
HoneyBaked Ham (Feb/Mar)
___ ___
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Spirit Store
___ ___
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Teacher Support
Room Parent
Room Parent Helper
Specialty Teacher Help
Art (includes Yearbook)
Library
Computer Lab
Music
Band
Performing Arts
Box Tops/Store Programs
Organize/Count/Send in Box Tops ___ ___
MAJOR SCHOOL FUNDRAISING
These two fundraisers help meet our budget shortfall. We need all families to participate, and help us
make the two events successful.
School Auction (Fall)
Mom Dad
Includes Silent Auction, Dinner and Live Auction.
Families bring in items for the Auction, each classroom does a project or basket for the auction.
Bring friends and family to the Auction and BID!
Co-Chair
___ ___
Planning
___ ___
Acquisitions
___ ___
Decorations
___ ___
Set up (if nec. decorate, tables) ___ ___
Set up Silent Auction Items
___ ___
Clean up/Tear Down
___ ___
Project S.H.I.N.E. (Spring)
Each classroom decides upon a “Service” that is
performed/completed the day of S.H.I.N.E. Students receive pledge cards. They go to neighbors,
family members, youth groups, etc to get pledges
for their time for “Serving.”
Co-Chair
___ ___
Planning
___ ___
Helper
___ ___
Helper
___ ___
(Help preparing for the service of child’s class, teachers day of SHINE, parties for “winners”, etc.)
See reverse side for additional school programs to volunteer for!
Updated 1/2017
VOLUNTEER / DONOR FORM (Continued)
These are additional opportunities for Option 1 service hours.
Picture Day/Health Screening
Picture Day
Fall
Spring
Spiritual Emphasis Team
Liaison to your church
Chapel Coordinator
BBOC (Dads praying)
Moms In Prayer
Academic Events Team
(judging, assist w/children)
ACSI Science Fair (Spring)
ACSI Spelling Bee (Winter)
ACSI Art Festival (Spring)
Athletic Events Team
Field Day (Spring)
Coaching
Sport _______________
Sports Boosters
Christmas/Spring Programs
Band/Dance/Christmas Concert Help
Band/Dance Spring Concert Help
Pianist
Talent Show
Dinner Theatre
Set Up
Clean Up
Mom
Dad
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If you have any questions regarding any of
these activities, please call 602-992-8140.
Copycats: This involves helping the teachers
with any photocopying they may have prior to
school starting and/or throughout the year.
Lost & Found: Clean out all the bins, hang
clothes on the fencing, pack up what is left to be
donated.
Table Washers: Wash the tables the students
eat at. This is done daily, and in the morning. It
takes about 30 minutes; fill a bucket with water and
cleaning solution and wash the tables with the
squeegee.
Coin Challenge: Gather gallon milk jugs, and
each morning for a specified week, collect coins
from the students. Set prizes, parties, etc, count &
take the pennies to the bank, help the teachers with
the prizes/parties. (A committee, needs 3-5 people).
Teacher Support: Let the teachers know of your
availability. This includes driving for field trips, organizing parties, organizing Class Projects for the
Auction, photocopying, and more. Our Specialty
Teachers need your help too: Music, Art, Band,
Spanish, Computer Lab, and Library.
OPTION 2: If parents cannot volunteer, they may donate $200.00 (per family) to help
cover costs of school operation. Please choose your payment plan below:
Parent Signature: _____________________________________ Date: ____________________
Please check the plan:
Whole Year Plan—Bill by September 1st
Half Year Plan—Bill September 1st and February 1st
Please complete the reverse side of this form with names, phone
numbers and emails. Thank you!
Driver Information/Release Form
Driver Name:____________________________________________________________________________
Driver License Number:___________________________________ Expiration Date:__________________
Child/ren Name(s):________________________________________________________________________
Field Trip Chaperone/Driver Information:
♦ Students assigned to you are your responsibility.
♦
♦
Students should be respectful and obedient at all times.
Please contact the teacher if there are any issues that are of a discipline nature.
♦
♦
Student safety is crucial. The bathroom buddy system is required if an adult is unavailable to accompany a
student to the restroom.
Students may not change vehicles without prior approval from the teacher in charge.
♦
Please do not take any side trips or divert from the original route. Please follow the established itinerary.
♦
Advise students of your personal car rules and expectations regarding food, drink, and voice tone and level
expected as a passenger in your vehicle.
The use of a cell phone while driving or supervising students is prohibited.
♦
Volunteer Driver Release:
As a volunteer driver for Paradise Valley Christian Preparatory, and using my own personal vehicle to transport
Paradise Valley Christian Preparatory students, I attest that I have a good driving record, that my vehicle is in good
repair and that I carry and maintain adequate insurance coverage as required by the State of Arizona of every driver
owning and operating a motor vehicle.
Further, as a volunteer driver for Paradise Valley Christian Preparatory events/functions, I hereby recognize and
acknowledge that I am fully and solely responsible for the safety, care and well-being of any and all PVCP students
riding in my vehicle; and, that in the event of an accident or mishap of any type whatsoever involving my vehicle and
PVCP students, I assume the primary position for any and all liability, medical and/or other damage claim(s) that
might arise.
By signing below, I acknowledge having read the above statement and my intent to comply with all terms and
conditions thereof.
_________________________________________
Signature
Copy of License:
11875 N. 24th Street
Phoenix, AZ 85028
Phone: 602 992-8140 •Fax: 602 992-8152
www.pvcp.org
PRIVATE SCHOOL AFFIDAVIT OF INTENT
Dr. Donald D. Covey – Maricopa County Superintendent of Schools
Maricopa County Education Service Agency
STUDENT INFORMATION:
NAME: ____________________________________________________________________ DATE OF BIRTH: ___________________________
(LAST, FIRST, MIDDLE)
SCHOOL DISTRICT OF RESIDENCE: __________________________________
PARENT/GUARDIAN INFORMATION:
NAME: ___________________________________________________________________ TELEPHONE NUMBER: _______________________________
(LAST, FIRST, MIDDLE)
HOME ADDRESS: _________________________________________________________ CITY: _________________________ ZIP: _________________
PRIVATE SCHOOL INFORMATION:
PRIVATE SCHOOL NAME: ___________________________________________________________________________________
Paradise Valley Christian Preparatory
Phoenix
85028
ADDRESS OF SCHOOL: _______________________________________________CITY:_______________________________
ZIP: ________________
11875 N 24th St
ARIZONA STATE PRIVATE SCHOOL LAWS FOR REGISTRATION AS PRESCRIBED BY THE ARIZONA REVISED STATUTES:
15-802 A: Every child between the ages of six and sixteen years shall attend a school and shall be provided instruction in at least the subjects of reading, grammar, mathematics,
social studies and science. The person who has custody of the child shall choose a public, private or charter school or a homeschool as defined in this section to provide instruction.
2. If the child will attend a private school or homeschool, file an affidavit of intent with the county school superintendent stating that the child is attending a regularly organized private
school or is being provided with instruction in a homeschool. The affidavit of intent shall include:
(a) The child's name.
(b) The child's date of birth.
(c) The current address of the school the child is attending.
(d) The names, telephone numbers and addresses of the persons who currently have custody of the child.
AUTHORIZATION:
PARENT/GUARDIAN SIGNATURE: __________________________________________________
Subscribed and sworn (or affirmed) before me this:
STATE OF: _________________________
______ day of________________, 20__________.
COUNTY OF: _______________________
NOTARY SIGNATURE: _________________________________________________________________
Submit this form either by mail or in person to the Private School Services Division at the address listed on the bottom of this page .
4041 N. Central Avenue, Ste. 1100, Phoenix AZ 85012 • Phone 602-506-3866 • Fax 602-506-3753
Homeschool Hotline 602-506-3144
www.maricopa.gov/schools
Known as experts. Renowned for service.