Southern Valley School District

Providing an opportunity for continued success.

SV Elementary Registration

73 Questions

Southern Valley Elementary Student Registration

1) Email Required*

Student Registration

2) Student's First Name Required*

3) Student's Middle Initial Required*

0 / 1

4) Student's Last Name Required*

5) Child's Preferred Name (optional)

6) Social Security Number (optional)

7) Resides With Required*

8) Ward of the State Required*

No

Yes

9) Street Address Required*

10) PO Box (if applicable) Required*

11) City Required*

12) State Required*

13) Zip Code Required*

14) Child's Date of Birth Required*

15) Birthplace (optional)

16) Home Phone (optional)

17) Cell Phone (Mom) (optional)

18) Cell Phone (Dad) (optional)

19) Gender Required*

Male

Female

20) Grade Required*

21) Ethnicity (Choose One) Required*

Hispanic/Latino

Not Hispanic/Latino

22) Race (Choose One or More regardless of Ethnicity Required*

23) Previous School Attended (optional)

24) Father's First Name (optional)

25) Father's Last Name (optional)

26) Father's Employer (optional)

27) Father's Work Phone (optional)

28) Father's Work Cell Phone (optional)

29) Mother's First Name (optional)

30) Mother's Last Name (optional)

31) Mother's Employer (optional)

32) Mother's Work Phone Number (optional)

33) Mother's Cell phone number (optional)

34) Step Parent/Foster Parent/Guardian First Name (optional)

35) Step Parent/Foster Parent/Guardian Last Name (optional)

36) Employer (optional)

37) Work Address (optional)

38) Work Phone (optional)

39) Cell Phone (optional)

40) NDHHS Case Manager Name (optional)

41) Case Manager Phone (optional)

Child Medical Information

42) Child's Doctor Required*

43) Phone Required*

44) Child's Dentist (optional)

45) Phone (optional)

46) Is it ok to call the above Doctor/Dentist in an emergency? Required*

Yes

No

47) Is it ok to call the ambulance in an emergency? Required*

Yes

No

48) Is it ok for the school staff to treat a minor accident (sliver, cut, scrape, bump, tick, etc.?) Required*

Yes

No

49) List any special conditions to be considered in an emergency (Examples: Penicillin reaction, fainting spells, etc.) (optional)

50) In case of emergency contact Required*

51) Phone Required*

52) List of Child's Allergies (optional)

53) Does your child have any of the following visual or hearing problems? (optional)

54) List medication administered at home (optional)

55) List medication administered at school (optional)

56) Does your child require any special services? (optional)

57) Individuals Who Have Permission to Pick up your Child Name (optional)

58) Phone (optional)

59) Relationship (optional)

60) Name (optional)

61) Phone (optional)

62) Relationship (optional)

63) Name (optional)

64) Phone (optional)

65) Relationship (optional)

66) Any Additional Information (optional)

Enter any details such as second parent or guardian who would like to receive school mailings (name & address)

Home Language Survey

67) What language did your child first learn to speak? (optional)

68) What language is spoken most often by your child? (optional)

69) What language is primarily used in the student's home regardless of the language spoken by the student? (optional)

70) Signature Required*

By signing, I am adding my digital signature to this form that as the Parent/Guardian/Foster parent, and certify that information is correct and arcuate as of the submission date.

Signature

I understand that my typed signature is the legal equivalent of my handwritten signature on this document.

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SV Elementary Registration

SV Jr/Sr High Registration

SV PreK Registration

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Southern Valley School District43739 HWY 89Oxford, Nebraska 68967(308)868-2222

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SV Student Registration/Inscripción de Estudiantes