STUDENT REGISTRATION
Valley Middle School
900 Garden View Drive Apple Valley, MN 55124
Phone: (952) 431-8300
FAX: (952) 431-8313
TODAY’S DATE: _______________
Circle Grade in Which Your Child is Enrolling: 6th 7th 8th
Child’s Legal Last Name: _________________________
First Name: ___________________
Birth date: ___________ Country of Birth: ______________________ Sex: ___________
Circle the Caretakers: FATHER MOTHER STEP-FATHER STEP-MOTHER or OTHER: _______________________
1st Parent’s Legal Last Name: _____________________ First Name: __________________
Cell Phn: __________________ Wk Phn: __________________ Hm Phn: _________________
2nd Parent’s Legal Last Name: _____________________ First Name: __________________
Cell Phn: __________________ Wk Phn: __________________ Hm Phn: _________________
YOUR ADDRESS In District 196
Street: __________________________________________ Apt #____________
City: ____________________________ Zip Code: __________________
Name of Your Child’s Previous School: _______________________________________
Street Address: ___________________________________________
City/State: ____________________________________________ Zip: ______________
School Phone #: ________________________ School Fax #:________________________
What is your child’s approximate grade in: MATH __________ ENGLISH/READING________
Was your child ever expelled or suspended from school? _____________________________
Is English Your Child’s Second Language?
YES
NO
If YES, What is your child’s Native Language? __________________________________
Check One Below
____No English _____Beginning English
_____Advanced English
Does Your Child Currently Receive Special Education Services and Have an Active IEP? YES NO
What is the area of disability? ____________________________________________________