Loudoun Valley High School
Student Directory
Complete this form ONLY IF YOU WANT YOUR CHILD INCLUDED
IN THE DIRECTORY. Fill in the information as you want it to appear
and please, PRINT CLEARLY!
Please include my child in the 2014 - 2015 Loudoun Valley Student
Directory.
I want a copy of the Directory. To defray the cost of printing the
directory, a $ 5.00 payment is required.
(Make checks payable to LVHS PTO)
Student Name: ___________________________
Circle One: Grade 9 or 10 or 11 or 12
Additional Student:
Student Name: ____________________________
Circle One: Grade 9 or 10 or 11 or 12
Parents/Guardian Names: _________________________
Street Address: __________________________________
Town: ______________________ Zip: ___________
Home Phone: ______________________
Email Address: _________________________________
This form is due back to school by Sept. 23rd – thank you!